
Class. toil 



Book 




h^C^ 




I 

MM 

, 1 



MEDICAL 

FACTS AND INQUIRIES, 

RESPECTING THE 

CAUSES, NATURE, PREVENTION AND CURE 
of 

FEYEM: ■ 

.MORE EXPRESSLY IN RELATION TO THE ENDEMIC FEVERS OF SUM- 
MER AND AUTUMN IN THE 

SOUTHERN STATES. 

TOGETHER WITH A HISTORY OF THE 

BILIOUS REMITTING FEVER 
OF ALABAMA, 

AS IT APPEARED IN CAHAWBA AND ITS YICINITV* 

IN THE 

SUMMERS AND AUTUMNS - 

OF 

1821 and 1822.. 



BY JABEZ W. HEUSTIS, M. D, 

Author of Physical Observations ancf Medical Tracts amines ea.rches '(Hi 
the Topography and Diseases of Louisiana. ¥ 



CAHAWBA: 

PRINTED BY WILLIAM B. ALLEN", 

1825. 



I 1 



*jf 



.SXSTRtCT OF ALABAMA, to wi*. 

Be it remembered, that on the third day of Ma} 7 , A.B. 1825, and in ' :i 
forty -ninth year of the Independence of the United States^f America, 
Jabez Wig-gins Keustis, of the said district, hath deposited in this office 
the titlqpof a book, the right whereof he claims as proprietor, in the words 
following", to wit: 

' 'Medical Facts and Inquiries, respecting 1 the Nature, Causes, Preven- 
tion and Cure of Fever: More especially in relation to the Endemic Fever 
of summer and autumn in the southern states ; together with a history of 
the Hdious Remitting- Fever of Alabama, as it appeared in Cahawba and 
its vicinity, iff the summers and autumns of 1821 and 1822. By Jabez 
W, Heustis, M. D. author of Physical Observations and Medical Tracts 
and Researches on the Topography and Diseases of Louisiana." 

In conformity to the act of the Congress of the United States, entitled, 
"An act for the Encouragement of Learning-, by securing- the copies of 
Maps, Charts, and Books, to the authors and proprietors of such copies, 
during- the times therein mentioned." — And also to the act, entitled "An 
act supplementary to an act, entitled, 'An act for the Encouragement of 
Learning, by securing the copies of Maps, Charts, and Books, to the au- 
thors and proprietors of such copies, during the times therein mention- 
ed,' and extending the benefits thereof to the arts of designing, engrav- 
ing-, and etching historical and other Prints." 

WILLIAM R. MORRISON, 

Clerk of the District of Alabama, 



CONTENTS. 



CHAPTER I. 

Of the causes of Summer and Autumnal Fevers in hot and tropical climates-*- 
Chemical and philosophical investigation of the preliminary circumstances 
of Endemic Fevers — Chemical analysis of the processes of putrefaction and 
decomposition. 

Pag-e . 
Section I. Introductory Remarks, .-_..- If 

Section II. Of the Processes of Putrefaction and Decomposition, 12 

Section III. Composition of the Atmosphere — Eudeometry no test 

of its purity, - 18 

Section IV. Economy of Vegetation, and its relation to the Causes 
and Origin of Endemic Fever, ------ 21 

Section V. Of Heat and Moisture, ------ 30 

Section VI. Of Miasmatic Exhalations, » 44 

CHAPTER II. 

Of the Nature, Origin, and Contagion of Endemic Fevers, 

Section I. Of the Nature and Origin of Endemic Fevers, - - 76 
Section II. Inquiry into the Doctrine of Contagion, Importation and 
Exotic Origin of the Yellow Fever, ..... 127 

j* CHAPTER ITT. 

Of the Predisposing and Exciting Causes of Endemic Fever, 148 

CHAPTER IV. 

Of the primary mode in which Infection or Miasma comes to operate 

upon the system in the production of Disease, 172 

CHAPTER V. 

Inquiry into the seat of Fever — Facts in support of the opinion that 
the immediate cause of Fever exists in the Circulating Fluids, 183 

CHAPTER VI. 

Penod of Infection — Of the length of time that elapses from the pe- 
riod of exposure till the appearance of the Disease, 193 

CHAPTER VII. 

Inquiry into the Theory of Fermentation and Putrefaction in Expla- 
nation of the phenomena of Fever , 195 

CHAPTER VIII. 

Qf the Proximate, Cw.se of Fever, 20 p 



CONTENTS. 

CHAPTER IX. 

t>f the Symptoms of Fever, 231 

CHAPTER XI. 

Prognosis of Endemic Fever, 243 

CHAPTER XII. 

■Appearances on Dissection, 25€ 

CHAPTER XIII. 

Of the Prevention of Fever. 

Section 1. Of personal remedies as Preventives of Fever, - 261 

Section 2. Of local remedies as preventives of Endemic Fever, 27? 

CHAPTER XIV. 

Curt of Fever — Preliminary Remarks. 

Section 1. Of the Cure of Intermitting Fever, - 289 
Section 2. Of the Operation of the Remedies employed in Intermit- 
ting Fever, 293 

Section 3. Cure of Remitting Fever, - - - - - 298 

Of Blood-letting, - - - - - - 298 

Of Emetics, 310 

Of Cathartics, 312 

Of Calomel, 319 

Of the Cold Bath, 324 

Of Cold Applications and Sponging the Body, - 332 

Of the Warm Bath, 334 

Of Febrifuge and Sudorific Medicines, - 336 

Of Blistering, 341 

Of Peruvian Bark, - 343 

Of Wine, - 344 

Of the Sulphate of Quinine, - - - - 347' 

Of Stimulating Drinks, - 347 

Of Mineral and Vegetable Acids, - - - - 348 

Of Opium, 361 

"Directions concerning Convalescents, - 364 

An account of the Bilious Remitting orEndemic Fever of Alabama, 
as it appeared in Cahawba and its vicinity in the summer and au- 
tumn of 1821, 371 

An account of the Endemic Fever of 1822, « .- = . . 418 



PREFACE. 



JT EVER is a disease of such common occurrence, that accord- 
ins: to Gorter one third, and according to Sydenham two thirds, 
of all the disorders to which mankind are liable, are of this de- 
scription ; and it has been a received opinion among physicians, 
that more than one half of the human race are destroyed by fe- 
ver alone.*' 

What an idea must we not have of the malignancy and fatality 
of the yellow or bilious fever of the West Indies, when we are 
informed by Dr. Home, that three out of four of his patients in 
Jamaica were destroyed by the disease ? This, however, is by 
no means equal to the mortality caused by the bilious fever in 
Natchez, in the summer of 1823 ; in which, out of four hundred 
persons that were tak*m sirk between the 15th of August and the 
20th of September, only twenty survived. 

The inhabitants of Europe, and of large manufacturing estab- 
lishments in our own country, are subject to a description of fe- 
vers called typhus, from the Sow nervous symptoms which- attend 
them ; these, as being of a local and more limited extent, are not 
the subject of the present inquiry. Those who wish to become 
acquainted with the typhus fever of England, may consult with 
advantage the ingenious work of Dr. Armstrong. Nor is it my 
d°sign to enter minutely into the discussion of the various forms 
and characters of febrile affections ; but my object is more es- 
pecially the consideration of those fevers which are obviously 
connected with and originate from heat of climate and noxious 
exhalations: or in other words, the endemic bilious and remit- 
tent fevers incidental to the wide extent of the United States, but 
especially to its southern section. Asa knowledge of these fe- 
vers, from the malignancy which they frequently assume, is of 
the greatest importance to the physician, so every attempt insti- 
tuted to investigate the laws by which they are governed, their 
nature, prevention and cure, must thence derive an importance, 
proportionate to the ability with which it is conducted. The 

* Burserius' Practice of Physic, p. 104. 



IV PREFACE. 

merits of this performance I leave for others to determine. — ■ 
Having, from careful and mature consideration of facts, drawn 
the most obvious and practical conclusions, I have at least satis- 
fied myself with respect to many particulars on the subject of fe- 
ver which have been hitherto neglected, or but slightly and im- 
perfectly remarked and understood. 

The outlines of these observations were drawn up during my 
residence in the southern portion of the United State?. Upon 
my return to the north, I consulted every writer within my 
reach who had treated on fever, and the relative branches con- 
nected with the subject. 

In thus presenting myself as an author before the public, I 
have maturely weighed the responsibility and importance of the 
step which I have taken. It is now nearly ten years *ince I 
first turned my attention to this inquiry, during which time I 
have carefully examined and considered the subject matter of 
investigation, so that it cannot be viewed in the light of a hasty, 
indigested essay, without maturity or experience, but as the re- 
sult of labor, study and observation. Such as it is, 1 now offer 
it to the public. In several instances I have found it necessary 
to prune, correct and enlarge the crude performance of my more 
juvenile years ; and although I have not the vanity to think that 
the present work is entirely free from errors and defects, yet I 
flatter myself that in every point of view these observations will 
be found of practical utility. 

No disease has been the theme of so much discussion as fever, 
and there is probably none upon which so much has been ad- 
vanced to so little purpose : but as every subject of scientific 
investigation must be progressive in its course to perfection, so 
by improving upon the experience and researches of our prede- 
cessors we may hope ultimately to arrive at the summit of hu- 
man perfection. I might here take up an investigation of the va- 
rious hypotheses that have prevailed in the medical world on the 
subject of fev^r, from the time of Hippocrates to that of Dr. Rush. 
But a labor of this description would prove as unprofitable in its 
result as it would be painful and tedious in its performance. 

The reader will perceive that I have taken a new view offe- 
rer, at least one quite different from any that has lately appeared. 
I have, indeed, endeavored to trace this disease through all its 
intricacies and meanderings of its causes and operations to its 
complete and final developement. And as the feveis which form 
the subject of the present work are known to be connected with, 
and to depend upon morbid changes and vitiations existing in the 
atmosphere, I have, as a leading inquiry, directed my attention 
to the chemical composition of this element, and have further 
attempted to show what it is that destroys the salubrity of the 
atmosphere in certain seasons and situations, and to point out 
the manner in which this state oi the air may be guarded against 
and prevented. 



PREFACE. V 

On the subject of contagion and importation, I have also dwelt 
at considerable length, and as I conceive hsve given it a fair 
and candid investigation. The practical purposes to which this 
branch of the inquiry more expressly applies, are the police of 
cities, the enforcement of quarantine regulations, and the inter- 
course of physicians, nurses and friends, with those laboring un- 
der disease The establishment of just principles, therefore, in 
relation to this subject, is of the first importance ; not only in a 
medical, but also in a civil and national point of view. 

In conducting this inquiry, facts were necessary to establish 
principles. Of these, therefore, I have availed myself to as great 
an extent as my time and opportunity would permit, or as the 
subject might seem to require. I may, perhaps, in the opinion 
of some, have adduced more examples in proof of the pernicious 
effects of putrid exhalations, than the general admission of the 
fact might seem to demand : yet in an investigation of this na- 
ture, it is highly necessary and proper that every individual 
should knotv the foundation and reason of his opinion and be- 
lief; and as the chief object in the prevention of diseases is the 
knowledge of their causes, it is evident that these cannot be too 
clearly defined and ascertained. 

The present is but a part of a more extended performance, 
the publication of which is for the present postponed ; and I find 
that in my delay in appearing before the public, I have lost much 
of the credit that I might otherwise have acquired. Thus the 
theory of ricke's advanced by Mr. Bonhomme, of France, and 
which has been successfully applied to practice, was entertained 
and advocated by the author of this work long before the publi- 
cation of the performance of Mr. Bonhomme. But in the pre- 
sent inquiry 1 believe I have not been anticipated. 

Some, perhaps, will dispute my claims to originality, both as 
it respects the theory of scurvy and fever. This, however, I 
must do myself the justice to say, that at the time this work was 
undertaken my mind was perfectly unshackled by prejudice or 
preconceived opinion ; and that the ideas that suggested them- 
selves were for the most part original and unborrowed ; and it 
was not till I had embarked in a general course of medical read- 
ing, with the view of qualifying myself as an author, that I dis- 
covered several coincidences of opinion between myself and some 
former physicians. But these coincidences which I occasionally 
observed on the part of others, were like random steps taken in 
total darkness ; where one by chance and possibility may be 
right, and where a hundred in probability will be wrong. They 
were detached and disconnected, in scattered fragments without 
order or design ; and clouded and beset with so many absurdi- 
ties, that it appeared clearly the writer had no distinct and defi- 
nite ideas upon the subject. One kind of scurvy, or fever, for 
instance, depended on an acid, another on an alkali, another on 
phlegm, another on salt or an unknown acrimony, and finally on 



VI PREFACE. 

all the elements, either singly or combined, earth, air, fire and 
water. These, by fermenting; and working, and mixing and strain- 
ing, and beating and cooling, and boiling; and foaming, produced 
all the various fbrrn^ and phenomena of frver 

" Fevers,'' says Hippocrates, " are caused by the bile and 
phlegm growing hot ; these mixing with the blood at first con- 
dense and cool it, and occasion the coldness and rigor ; after- 
wards they heat the blood and produce the hot stage."* No 
better founded a«*e the opinions of many of bis successors, who 
have attempted to account for the nature, of disease^ upon the 
supposition of certain qualities and mixtures of the different flu- 
ids of the body ; for as the properties of these were unknown, 
of course all reasoning upon their mixtures, changes and chemi- 
cal action, could have been nothing more than the erroneous ' 
vagaries of mere speculation. "Experiments," says Dr. For- 
dyce, "can only determine the condition of the fluids of the 
body. Every thing, therefore, that is said with regard to the 
fluids before the time their properties were investigated by ex- 
periments, excepting some of the externa! appeal ances of some 
ot the secreted fluids, is to be entirely passed over as not at all 
relevant to the explanation of the causes of this disoase, (fever,) 
or the history of it in any manner. The first part of the blood 
which was distinctly marked was the serum. Some person about 
a century and a half ago discovered the red particles. Even 
Boerhaave was unacquainted with the coagulable lymph ; and 
the properties and varieties which take place in these three es- 
sential parts of the blood, are even not well known to the ma- 
jority of practitioners in Europe. It would appear, therefore, 
that there is very little ground for resting the cause of disease, 
whether it be fever or any other, on what has been affirmed of 
the properties of the fluids by rmmjr, even practical authors, 
for they knew them not, and did not examine them."| " From 
Willis to Fothergill," says Dr. Beddoes, " and from Fothergill 
downwards, scarce any real observation occurs upon the state 
of the blood. One tells us that it is polluted, another that it is 
contaminated, a third that it is acrid, a fourth that it is putres- 
cent, without recollecting that to employ terms expressive of 
phenomena, such as the senses may recognize, and to reason 
upon such phenomena alone, are indispensable conditions in 
philosophizing.":}: 

In taking the view of the subject here presented to the pub- 
lic, practical conclusions are established, founded on the latest 
discoveries and improvements in medical philosophy. As in 
the time of Dr. Cullen, an investigation of the nature of dis- 
eases on the principles of the humoral pathology would have 



* Hippoc. De Morb. Lib. 1. 

t Geo Fordyce on Fever, Sec. p. 158. 

t Beddoes' Observations on Sea Scurvy, &c. p. 152. 



PREFACE. VU 

been in a great decree Unsuccessful and abortive from the im- 
perfect knowledge of animal chemistry at the time, in like man- 
ner '.he nature and phenomena of many diseases remained unex- 
plained. Many of these difficulties mo longer exist, and in the 
present work I have called to my aid the latest improvements 
in medical srience. 

In my attempt to contribute to the cause of my profession. I 
have aimed at some fundamental pathological conclusions, and 
have endeavored to establish a practical theory, founded upon 
the sure h.isis of fiets and demonstration. It is the custom of 
many to decry theory in physic as vain and unprofitable specu- 
lation, and to insist upon the superior advantages of experience, 
as the only and essential qualification for successful practice. — 
But it was well observed by Dr. Beddoes, and the same idea is 
expressed by Dr. *. T -.>ore, thai there are few diseases in which 
we have any fixed rules q£ practice, and our"specjfics are so few, 
and so easily applied, that this part of medicine may be acquired 
without difficulty or loss of time. In some instances a theoreti- 
cal deliberation of some sort must precede prescription, and 
here the discrimination' of persons habituated to speculation will 
have the superiority of skill over chance, and their facility of 
resources wiJ) appear to peculiar advantage. For, a,s observed 
by Dr. ftioo're^? some diseases appear in such a questionable 
shape, that the most knowing are puzzled to decide to what class 
the* belong, and the combined powers of experience and saga- 
city have sufficient employment in treating them. " He who 
draws medical knowledge from books alone," says Dr. Moore, 
41 and whose exalted notions have not been moderated by expe- 
rience, will practise medicine as the philosopher who declaim- 
ed on the art 6f war to Hannibal would have commanded an ar- 
my ; but he who has seen much practice without reasoning, as 
one of Cannibal's pioneers , and he who to extensive experi- 
ence join* the greatest natural acuteness and all the powers of 
ieasonrng, as Hapnibal himself." And it is well observed by 
Dr. Rush, that " a single principle in our science will lead to 
more truth in one year, than whole volumes of uncombined facts 
will do in a century." 

As this work consists more in demonstration than in theoreti- 
cal speculation, the facts and illustrations, to whatever purpose 
they m; \y * >e applied by others or myself, must be considered of 
essential practical importance. 

My original desigu was, at first, merely to embrace an histori- 
cal account and medical illustration of the epidemics of the years 
1821 and 1822; but with the view of rendering the work the 
more generally useful and interesting to the medical reader and 
to the public at large, I have thought proper to embrace a gene- 
ral history of the causes and treatment of endemic fevers as they 

* Medical Sketches. 



Vlll PREFACE. 

occur in various places and seasons in the United States ; adapt- 
ing the practice more especially to the fevers of the southern 
section of our country. And with the design of rendering this 
treatise the more profitable, I have enlarged upon the practi- 
cal part considerably more than if I had intended it exclusively 
for the experienced physician. In this, however, the inexperi- 
enced will find an advantage ; for it often happens that the young 
practitioner, who has been more familiar with theory than the 
bed-side ofthe sick, finds himself materially at a loss on approach- 
ing his patients, at the diversified character of diseases : and 
upon consulting his best authorities, he is still left in doubt and 
uncertainty. The general treatment of diseases is described, 
but so many particulars are omitted, that he finds himself, in a 
great measure, thrown upon the resources of his own judgment 
and discretion. To obviate these inconveniences, and to render 
the work useful to the general community, I have extended the 
subject of the prevention and cure of fever considerably beyond 
ray original design. As it respects the treatment of fever of 
1821 and 1822, I have spoken almost entirely from my own ex- 
perience : and what has been omiited under these heads may be 
found discussed at large under the general treatment of fever in 
the previous part ofthe treatise. Accounts of the fever of 1821 
and 1822, will be found in the latter part ofthe present work. 

In the execution of this performance some inaccuracies have, 
perhaps, escaped me, as the authorities referred to were prin- 
cipally taken in manuscript during my residence in New- York, 
in the years 1815, '16, and '17 ; and the impossibility of again 
consulting them on the present occasion, must be my apology for 
the few orthographical errors that may be detected. 

As the sense in which the words epidemic and endemic should 
be received, has not hitherto been accurately defined by medical 
writers, it may be thought necessary for me to explain the ac- 
ceptation in which I employ them. An endemic may be defined, 
a disease incidental to a country or tract of country, and such as 
from local peculiarity of climate and situation, or similarity of 
constitution, frequently occurs : thus the bilious remitting or 
yellow fever is an endemic of the East and West Indies, and of 
various parts ofthe United States. As in each place it has some 
symptoms which are not observable elsewhere, each district and 
section of country may be said to be liable to an endemic pe- 
culiar to itself. The itch is an endemic in Scotland, and the 
plica Polonica in Poland. Now as the season and situation may 
be more or less unhealthy, the endemic may be epidemic or spo- 
radic ; epidemic, when it attacks a large proportion of the peo- 
ple ; sporadic, when it affects only a few scattering individuals. 
This is the construction which I give the words epidemic and 
endemic ; making endemic the class, and epidemic and sporadic 
the orders. But there may exist an epidemic w ithout an endem- 
ic disease ; as is the case with most contagious disorders, as the 



PREFACE. IX 

small pox, meazles, chicken pox, &c. as likewise influenza and 
the spotted fever. As these are incidental to every country, 
and confined to no one in particular, they cannot, with propriety, 
be called endemics. 

By designating the summer and autumnal bilious fevers of the 
United States, whether appearing in large cities and sea-ports, 
or in inland situations, the endemic fever of the country, I have 
endeavored to simplify the subject, and to disrobe it of that mys- 
tery and terror with which some physicians have endeavored to 
invest it. A fever originating from offensive docks and filthy 
streets has received the frightful appellation of the yellow fe- 
ver ; but to designate by that name a disease arising under simi- 
lar circumstances of heat and putrefaction in the interior of the 
country, would by the advocates of imported contagion be con* 
demned as heterodox in the extreme. In the view which I have 
taken, I have considered all the modifications of summer and 
autumnal fevers as the same disease, diversified, however, in 
different seasons and situations, in form, violence and degree ; 
but in every instance originating from similar causes. 



OF THE CAUSES. NATURE, PREVEN- 
TION AND CURE OF FEVER. 



CHAPTER I. 

Of the causes of Summer and Autumnal Fevers in hot anitrop* 
ical climates — Chemical and philosophical investigation of 
the preliminary circumstances of Endemic Fevers — Chemi- 
cal analysis of the process of putrefaction and decomposition* 

SECTION 1. 

Introductory Remarks. 

FROM a consideration of the circumstances which are 
generally connected with the origin of fever, there can be 
little doubt that the most frequent cause of it consists in that 
vitiated condition of the atmosphere occasioned by animal 
and vegetable decomposition; so that whatever favors and 
promotes this process must equally favor the production of 
fever. 

It must be obvious to every person, of even the most lim- 
ited observation, that the salubrity, or unhealthiness of cli- 
mates is essentially modified by the temperature and condi- 
tion of the atmosphere, and by the physical processes which 
are constantly taking place on the surface of the earth. Thus 
we find that a high degree and long continuance of heat du- 
ring the summer and autumnal months, give rise, in various 
situations, to bilious diseases. We as regularly observe, on 
the other hand, that the cold of approaching winter puts a 
stop to the prevalence of these diseases ; hence we infer 
with as much certainty, as from the alternate vicissitudes of 
light and darkness, which take place upon the rising and 
setting of the sun, that this luminary is the source of light; 
with the same certainty we infer that the prevalence and 
declension oi bilious diseases are owing to the successive 



12 Remote Causes of Fever. 

vicissitudes of heat and cold, in connexion with other physi- 
cal circumstances, which is the object of this history to point 
out and ascertain. 

One of the most striking effects of a high temperature is 
the decomposition or destruction which it occasions in dead 
animal and vegetable substances. The immediate conse- 
quence of this decomposition is the escape of elastic gases, 
and the corruption or vitiation of the surrounding atmos- 
phere. The effect of this contamination of the atmosphere, 
as determined by extensive observation, is the production 
©f endemic and epidemic diseases. 

Thus we find that the same sun which warms and cher- 
ishes the seasons, affording life, support, activity, and beau- 
ty to the animal and vegetable world, is also, to the human 
race, the prolific parent of diseases and death. 

Previously to entering into an investigation of the more 
immediate causes of fever, I shall, therefore, premise a short 
account of some preliminary circumstances ; as the process 
of putrefaction and decomposition ; a chemical considera- 
tion of the atmosphere; the vitiations and changes to which 
it is liable ; together with the theory of vegetation. 

SECTION 2. 
Of the processes of putrefaction and decomposition. 

The circumstances required for the putrefaction of dead 
animal and vegetable substances, are heat, moisture, and ex- 
posure to the atmospheric air. The temperature most fa- 
vorable to the process, seems to range between 15 and 95 
degrees of Fahrenheit. A higher degree of heat, by dissi- 
pating humidity, impedes or suspends the process. The 
degree of heat necessary to putrefaction, is much inferior 
to what is required for spirituous and acetous fermentations, 
for putrefaction take place at the temperature of 45°; but 
a higher temperature is still more favorable, at least if 
the heat be not so violent as to volatilize and dissipate all 
the moisture of the putrescent substance, and render it en- 
tirely dry. Access of air is another circumstance especial- 
ly favorable and necessary for putrefaction, for it is found 
that vegetable substances are preserved in vacuo. 

A certain degree of moisture is indispensably necessary 
for decomposition. When animal bodies are suddenly de- 
prived of their humidity and aqueous juices, they become 
hard, dense, and incorruptible, like petrifactions. This is 
exemplified in the arid and sandy deserts of Egypt and Ara- 



Remote Causes of Fever. 13 

bia, and also in some parts of South Americp. ; where, not- 
withstanding the heat of climate, the dryness of the atmos- 
phere and soil prevents putrefaction by the rapid exsiccation 
of the animal juices which it occasions. By an increase of 
caloric, the quantity of water which the atmosphere is ca- 
pable of holding in solution, is also increased. Now the 
air in passing over these parched and sandy deserts, where 
there are no trees, herbage, nor aqueous exhalations to re- 
fresh it, becomes intensely heated by the scorching sun, so 
that its capacity for water is greatly augmented ; from which 
circumstance it happens that every thing is robbed of its 
humidity which is capable of affording it, and animal bodies 
are converted into mummies. We are informed by the 
learned Dr. Shaw, in his travels from Egypt to the Holy 
Land, that he saw in the deserts, the bodies of some dead 
camels, which had belonged to a former caravan, and re- 
maining in a state of preservation, entirely free from putre- 
faction.* 

*The destruction of caravans and travellers in the deserts of Asia and 
Africa, is frequently caused by the fatal breeze called Samid wind, a blast 
of which, in those parched deserts, proves instantly fatal to the unfortunate 
traveller or beast, that may be exposed to it These winds seem to pro- 
duce death by suffocation, in consequence of their depriving the lungs of 
the ability to perform their function, and not by any pestilential poison »n 
the air itself It appears from the experiments of Dr. Priestley, that oxygen 
gas will not act upon the blood through dry membrane, and that a moist 
state is necessary for this purpose. This dry and parched air of these sandy 
deserts instantly absorbs the moisture from the delicate membrane forming 
the air cells of the lungs, and thereby prevents the oxygen of the atmos- 
pheric from performing its purifying operation upon the blood. The effects 
of this air upon the surface of the body, are similar to those upon the lungs ; 
it shuts up the pores of the skin, and puts an entire stop to perspiration. 
These reflections were made previous to my seeing- those of Mr. Volney 
upon the same subject ; who says> in his description of the Kamsyn, (which 
may be considered the same as the Samiel) that the lungs are irritated by 
the presence of this air, are contracted and rendered crisp. " Thi6 wind,'" 
continues he, " crisps the skin, evaporates animal moisture, closes the pores, 
and produces febrile heat which always accompanies suppression of the 
perspiration." The effect of this hot suffocating blast or vapour, (the Sa- 
miel) says Dr. Lind, on the human body, even when mitigated by passing 
through a moist atmosphere, is the same as that of intense cold ; it shuts up 
every pore of the skin, and entirely stops the perspiration of such as are 
exposed to it. They come on only in the day time, and always from the des- 
erts. Water is the only known antidote or corrector of this vapour. {Lind 
on H&t Climates, p. 144.) It appears from the experiments of Saussure, that 
a cubic foot of atmospheric air will hold eleven grains of water in solution ; 
from five to ten grains, however, is the usual quantity contained in every 
cubic foot. A certain degree of humidity is necessary to preserve substan- 
ces upon the surface of the earth in a proper state of moisture and pliability. 
During a season of the year the wind called the Harmatan prevails in the 
interior of Africa, which is so extremely dry, from passing over the sandy 
deserts, that furniture of houses is destroyed by it, the floors and joints of 



14 Remote Causes of Fever. 

It is owing fo a want of access of air to favor decomposi- 
tion, that the accumulation of soil constituting peat and 
morass is so inert and unproductive. Ihe cultivators of 
cotton about Eaton Rouge, and the iower parts of the Mis- 
sissippi, as they find the top of the soil which is alluvial, im- 
poverished by repeated crops, remedy the evil hv ploughing 
deep with a strong team of cattle, thereby exposing the 
mould, which has been hitherto excluded from the air, and 
again rendering the earth fertile and productive. 

buildings are laid open, and the scarfskin on the human body is rendered 
crisp and peels off. 

We are informed by Wafer, an English surgeon, that he and *-ome others 
landed at Virmejo, in South America, in I6b7, and marched about four 
miles up a sandy bay. " All whic h," he says, "we found covered with the 
bodies of men, women and children ; which lay so thick, that a man might, 
if he would, have walked half a mile, and never trod a step off a human 
body. These bodies to appearance seemed as if they had not been above a 
week dead ; but if you handled them, they proved as dry and light as a 
sponge, or a piece of cork. After we had been some time ashore, we es- 
pied a smoke, and making up to it. found an old man, a Spanish Indian, who 
was ranging along the sea-side, to find some dry sea-weeds, to d;e?s some 
fish, which his company had caught ; for he belonged to a Spanish boat hard 
by. We asked him many questions in Spanish about the place, and how 
the dead bodies came there. i'o which he returned for answer, that in his 
Father's time, the soil there, which now yielded nothing, was greeu, well 
cultivated, and fruitful. 1 hat the city of Wormia had been well inhabited 
by Indians, that they were so numerous, that they could have handed a fish 
from hand to hand twenty leagues from the sea, until it had come to Inca's 
hands ; and that the reason of these dead bodies was, that when the Span- 
iards blocked up and laid siege to the city, the Indians, rather than be at 
the Spaniards' mercy, dug holes in the sand and buried themselves alive, — 
The men as they now lie, have with them their broken bows, and the wo- 
men their spinning wheels and distaffs with cotton yarn upon them." Voy- 
age and Description of the Isthmus of Atncrica. 

Fuzier, a French voyager, who was also in Peru in 1712, confirms the 
same account. He says, lt . The vale of Hi'o, in which there are not at 
present more than three or four families maintained an Indian town, the 
remains of which are still to be seen, two leagues from the sea ; a dismal 
effect of the ravages the Spaniards have made among the Indians. There 
are still more moving marks of the misfortunes of that poor nation, near 
Aric'a, above the church of Jlilo, and all along the shore as far as the point 
of Colos, being ?u infinite number of tombs, that when they dig up at this 
very time, they find bodies almost entire, with their clothes, and very often 
gold and silver vessels. Those 1 have seen are dug up in the sand, the 
depth of a man, enclosed with a wall of dry stone ; they are covered with 
v.ai* els and canes, on which there is a layer of earth, and sand laid over, 
that the place where they were might not be observed They were so ter- 
rified that they thought they must die, when they were informed that the 
Spaniards had not spared their beloved Atalahalpa, who among them was 
looked upon as the offspring of the sun, which they worshipped. Therefore 
to escape out of their hands, they lied as far as they could eastward, to im- 
plore the mercy of the sun ; but being stopped by the sea, they buried 
themselves alive on the edge of it." Relation die Voyages de la Mer du Sud. 
The preservation of these bodies appears to have been the effect of dryness 
and exclusion from atmospheric air. 



Remote Causes of Fever. 15 

The influence of heat and moisture in favoring decompo- 
sition seems to consist in expanding and attenuating the 
corruptible substances, thereby enabling the elementary 
matters to come more intimately within the sphere of 
each other's attraction. Animal substances are more prone 
to decomposition than vegetable matter, on account of the 
laxity of the former, and their consisting of a greater num- 
ber cf elements, which begin to exert their respective affi- 
nities as soon as the vital principle is extinguished. These 
vegetable substances, which consist of but one or two ele- 
ments, as wax. resin, gum, oil, under ordinary circumstances, 
are scarcely susceptible of decomposition. Atmospheric 
air is necessary to this process, by affording the principles 
with which the decomposing matter may combine. This is 
illustrated in the preservation of vegetable substances in 
vacuo. Accession of air, however, is a less essential re- 
quisite than heat and moisture, since the phenomena of pu- 
trefaction sometimes take place without exposure to it, es- 
pecially in animal substances.* 

* Tha following account of the singular discovery of the carcass of a 
mammoth, given by professor Cuvier, as taken from a report in the supple- 
ment to the Journal du Nord, No. 80, by M. Adams, adjunct member of 
the Academy of St. Petersburg, is interesting, as affording an illustration of 
the preservative power of cold upou dead animal bodies, and of the neces- 
sity of heat for their putrefaction. As no account of this animal is preserv- 
ed in natural history, and as the only knowledge we possess of its former 
existence is from the remains which have been discovered, it is probable 
that this carcass might have been preserved in this block of ice more than 
two hundred years previous to its discovery. By what accident, convul- 
sion, revolution, or phenomenon of nature, it became placed in this situa- 
tion, is not the object of the present inquiry to investigate. 

"In the year 1799, a Tungusian fisherman observed a strange shapeless 
mass projecting from an ice bank, near the mouth of a river in the north of 
Siberia, the nature of which he did not understand, and which was so high 
in the bank as to be beyond his reach. He went next year, observed the 
same object, which was then rather more disengaged from among the ice, 
but was stdi unable to conceive what it was. Towards the end of the fol- 
lowing summer, 1801, he could distinctly see that it was the frozen carcass 
of an enormous animal, the entire flank of- which, and one of its tusk«, had 
become disengaged from the ice. In consequence of the ice beginning to 
melt earlier and to a greater degree than usual in 1803, the fifth year of this 
discovery, the enormous carcass became entirely disengaged, and fell down 
from the ice-crag on a saud-bank, forming part of the coast of the Arctic 
Ocean. In the month of March, of that year, the Tungusian carried away 
the two tus ks, which he sold for the value of fifty rubles : and at this time 
a drawing was made of the animal, of which 1 possess a copy. 

** Two years afterwards, or in 1806, Mr. Adams went to examine this ani- 
mal, which still remained on the sand-bank where it had fallen from the ice, 
but its body was then greatly mutilated. The Jukuts Of the neighborhood 
had taken away considerable quantities of its flesh to feed their dogs ; aid 
the wild animals, particularly the white bear, had also feasted on the car- 
cass ; yet the skeleton remained quite entire, except that one of the 



16 Remote Causes of Fever, 

In the chemical composition of animal substances, are 
discovered, hydrogen, which is the principal base, combined 
with a large portion of nitrogen, charcoal, oxvgen, phospho- 
rus, and not unfrequently sulphur. All the fluids, and what 
are called the soft solids of the animal body, undergo de- 
composition with gr »ater or less rapidity when exposed to 
a temperature of 65° or msre. When exposed to the 
air under such a temperature, the muscular fibre becomes 
pale, soft, and relaxed^ exuding a coloured serocity ; with 
the destruction of its organization, its smell becomes insipid 
and disagreeable; the altered substance, by degrees, de- 
creases in bulk, and its smell becomes ammoniacal. After 
this, if it be preserved in a close vessel, the putrefaction 
proceeds more slowly, and nothing but an alkaline pungent 
smell is perceived from it ; the matter effervesces with acids, 
and turns syrup of violet green. But when air is admitted, 
this urinous exha'ation goes off, and a peculiar, suffocating, 
putrid smell is rapidly evolved. This smell, says Fourcroy, 
continues for a long time, penetrates every where, and 
seems to affect the bodies of animals, like a fermenting sub- 
stance, capable of alteHng their fluids. This smell is cor- 
rected, and in some measure confined by ammonia : the lat- 
ter substance, formed by the union of the nitrogen and hy- 
drogen of the animal matter, is one of the principal gaseous 
results of putrefaction. It is evidently this, says Accum, 
that fills the cavities of the celular texture, so as to inflate 
and puff up the body. After the volatilization of the am- 

legs was gone. The entire spine, the pelvis, one shoulder-blade and three 
legs, were still held together by their ligaments, and by some remains of 
the skin ; and the other shoulder-blade was found at a short distance. The 
head remained, covered by the dry skin, and the pupil of the eyes was still 
distinguishable The brain also remained within the skull, but a good deal 
shrunk and dried up ; and one of the ears was in excellent preservation, 
still retaining a tuft of strong bristly hair. The upper-lip was a good deal 
eaten away, and the under lip was entirely gone, so that the teeth were 
distinctly seen. The animal vas a male, and had ? long mane on its neck. 
" The skin was extremely thick and heavy, and as much of it remained 
as required the exertions of ten men to carry away, wnich they did with 
considerable difficulty. More than thirty pounds weight of the hair ^nd 
bristles of this animal were gathered from the wet sand bank, having been 
trampled into the mud by white bears, while devouring the carcass. Some 
of the hair was presented to our Museum of Natural History, by M. Targe, 
censor in the Lyceum ot Charlemagne. It consists of three distinct kinds. 
One of these is stiff black bristle?, a foot or more in length ; another is 
thinner bristles, or coarse flexible hair, of a reddish brown colour ; and the 
third is a coarse reddish-brown wool, which grew among the roots of the 
hair. These afford an undeniable proof, that this animal had belonged to 
a race of elephants inhabiting a cold region with which we are now unac- 
quainted, and by no means fitted to dwell in the torrid zone. It is also evi- 
dent that this enormous animal must have been frozen up by the ice at the 
moment of its death." 



Remote Causes of Fever. 17 

monia, the putrefaction proceeds with new energy : phos- 
phureited and sit! phure tied hydrogen gases are disengaged, 
lastly carburetted. or, oxy-carburetted hydrogen gases are 
evolved ; it now shrinks again, its colour is altered, and the 
fibrous texture of the flesh is now scarcely distinguishable ; it 
is converted into a soft pulpy matter, of a brown or greenish 
colour ; its smell is insipid and nauseous, but acts wi<h great 
energy on animal bodies. This odorous principle, at length, 
loses its strength, the fluid part of the flesh becomes, in some 
measure, consistent: its colour becomes deeper; and it is 
at last reduced to a friable matter, half dry, yet deliques- 
cent, whirh by friction with the fingers, breaks into a coarse 
powder, like earth. . 

A much lower temperature is required for the putrid fer- 
mentation of vegetable substances, than for the vinous or 
acetous : decomposition takes place in a medium of 45°; 
but a higher degree of heat is much more favorable to the 
process, provided it is not so great as to entirely dissipate 
moisture. When vegetable substances putrefy, they be- 
come turbid, lose their colour, and deposit various sedi- 
ments ; if immersed in water, bubbles ascend to the surface, 
8nd a green mould gathers on the surface at the beginning 
of the alteration. Soft vegetable matters, exhibit the same 
appearance on being wet or exposed to damp. The com- 
motion produced, is not so considerable as that which ap- 
pears in the cases of spirituous and acetous fermentations: 
the cecornposing vegetable substances do not increase in 
size, nor is their temperature augmented : a change of smell 
is remarkable with a urinous odour, and towards the end of 
the process, ammonia is evolved. The latter, however, is 
disengaged in greatest abundance from the vegetable sub- 
stanees that contain nitrogen in their composition, and 
thereby more nearly approach to the chemical properties 
of animal matter ; such as cabbages, potatoes, onions, the 
flour of wheat, the tetridinamious class of plants, mush- 
rooms, gelatinous vegetables, &c: this approximation to the 
chemical composition of animal substances increases the 
tendency of these vegetable matters to spontaneous decom- 
position. In the decomposition of vegetable substances, 
there is not, in general, as in the putrefaction of animal mat- 
ter, any disengagement of the putrid combinations of sul- 
phuretted and phosphuretted hydrogen gases. _ Of all the 
elastic aeriform emanations, carburetted hydrogen gas is that 
which seems to be evolved in the most considerable quan- 
tity from decomposing vegetable matter. It is this which 
is constantly exhaling from swamps and morasses. Di\ 
c 



18 Remote Causes of Fever. 

Seybert. of Philadelphia, found the quantify of this gas, dis* 
engaged from a mixture of mud and water, so great as to 
occasion a violent explosion of the bottle in which the mix- 
ture was made. As this gaseous compound is the most abun- 
dant product of spontaneous decomposition in the moulder- 
ing mass of extinct vegetation, so does it seem to be the 
most essential requisite and principal ingredient in the econ- 
omy of vegetable growth. Ail vegetable substances ulti- 
mately undergo decomposition. The greater or less facili- 
ty, however, and the rapidity with which this process takes 
place, depend upon the different states of laxity or density 
in their texture, -and their being more or less soluble in wa- 
ter. Those which are the most soluble are the soonest to 
undergo decomposition. 

From the evolution of ammonia, putrefaction has been 
called alkaline fermentation, and ammonia considered as its 
product. Towards the close of the decomposition of veget- 
able substances, the pungency which is exhaled in the height 
of the process has become dissipated, and is succeeded by a 
degree of nauseous insipidity. The decomposition having 
attained its height, the putrid vegetable mass, becoming 
very soft, sinks down into a gelatinous consistence, and the 
odorous principle exhaling from it undergoes many succes- 
sive modifications ; at length, losing its disagreeable smell, 
it becomes dry ; and a blackish, carbonaceous residuum re- 
mains, known by the name of humus vegetabile, consisting 
of saline and earthy substances. 



SECTION 3. 

Composition of the atmosphere — Audiometry no test of its purity. 

The atmosphere may be considered as a great chemical 
laboratory and receiver, in which all the attenuated and vo- 
latilized productions of terrestrial bodies are received, min- 
gled, agitated, combined, and separated,* and although the 
two essential constituents of the aimosphere are nitrogen 
and oxygen, in the proportions of twenty-one parts of the 
latter to seventy-rive of the former,! yet from the various 

* Park's Chem. Catechism. 

t The precise proportions of these elements, together with aqueous vapour 
and carbonic acid gas, which are alwa\s present, according to Mr. Henry 
are as follows • 

Nitrogen gas, 75.5 by measure, 75.55 by weight. 

Oxygen gas, 21 23.32 

Aqueous vapour, 1.42 1.03 

.8 .10 



Remote Causes of Fever, 19 

chemical combinations and decompositions which are al- 
most constantly taking place upon the surface of the earth, 
the air which we breathe is liable to be vitiated by the va- 
rious admixture of heterogeneous substances, deleterious in 
their properties to animal life, and foreign to the composition 
of the atmosphere itself. The nitrogen and oxygen which 
form the atmosphere, are merely in a state ot mixture, not 
of chemical combination : audit has been proved by Mr. 
Dalton, that whenever two or more of the permanently elas- 
tic fluids come in contact, they penetrate each other, and 
form an equable mixture ; and that, therefore, a lighter gas 
cannot for any considerable time float upon the surface of a 
heavier, but the mixture of the two elements becomes inti- 
mately diffused and blended ; in the same way that distilled 
spirits, which is a lighter substance than water, becomes in- 
timately blended with it, when poured into and agitated in 
the same vessel. 

As already observed, the atmosphere is liable to become 
contaminated by various admixtures foreign to its nature, 
resulting in a great degree from the decomposition of animal 
and vegetable substances. The degree of this vitiation, 
however, is not to be determined by chemical tests ; the 
most certain, and indeed the only criterions by which it can 
be ascertained, are the appearance of physical causes, and 
the morbid effects produced upon the human constitution. 
Philosophy may blush for the imperfection of her boasted 
wisdom and sagacious powers of investigation, when it is 
considered that the constitution of man is the only infallible 
eudiometer,* by which the purity or impurity of the atmos- 
phere can be satisfactorily known. The experiments of Dr. 
Priestley, and the researches of De Marti, have ascertained 
thai the air of places the most offensive and unwholesome, 
affords as much oxygen as that of others of an opposite de- 
scription ; the air, for example, of crowded cities, on the 
summits of the loftiest mountains, and in the bottoms of the 
deepest vallies, has not been found to vary in the propor- 
tion of its two constituent elements ; the noxious qualities 
of the atmosphere depending, not on the deficiency of oxy- 
gen, but on the admixture of deleterious substances, beyond 
the power of eudiometry to detect. It is a lamentable fact, 
that such is the imperfection of science, and the grossness of 
chemical experiments, that eudiometry can discover no dif- 
ference between the air of an infected prison, the atmos- 

* An eudiometer is an instrument or apparatus employed for measuring 
the purity of the atmosphere. 



20 Remote Causes of Fever. 

phere of a swamp loaded with sickly vapor?, and the delete- 
rious products of animal and vegetable decomposition, and 
that of the most salubrious situations. It even appears from 
the experiments of Dr. Davidson* of Martinique,* that the 
atmosphere of the tropics contains a greater proportion of 
oxygen than that of northern climates. These experiments 
are confirmed by those of Dr. Chisholm. M S&guiiie has, 
also, anahzed the air of hospital wards, which had been con- 
stantly shut up for the space of twelve hours, and, for all that 
he could discover, it appeared to he almost as pure as the 
open atmospheric air, although it had an insupportably of- 
fensive smell. Bertholet, likewise, in his analysis o( the 
atmosphere, found that the air of Egypt did not differ in its 
physical and chemical properties from that of the most salu- 
brious climates of Europe ; and this was demonstrated even 
when the plague prevailed in that country. To these curi- 
ous facts may he added the experiment contained in the me- 
moir of Gattini. This experiment was made August 1.5'h, 
1779, on the stagnant air of the offensive marshes of Fort 
Fuentis. at the mouth of the river Vatteline, where bilious 
fevers constantly prevail in the summer season. And such 
is the unhealthiness of this place, that, according to Gattini, 
whoever ventures to sleep in that situation during the sum- 
mer season, is sure to be attacked by an intermittent: the 
air of that place was compared with the air on the summit 
of Mount Legnone, which, always covered with snow, forms 
a chain with the lofty mountains of the Grisons, and is ele- 
vated above the level of the sea about 8,640 [cct. On com- 
paring these two portions of air in the eudiometer, with the 
urmost exactness, the air of the marshes was found to be 
two degrees purer than that from the summit of Legnone. 
Though this experiment was repeated as often as fifteen 
times, varying all the circumstances of time, season, &c. 
the result was still the same. 

That the air of the infected places where these experi- 
ments were performed was contaminated, there can be no 
question; that this vititiation was not discoverable by the 
tests employed, proves the imperfection of these experi- 
ments themselves, and leaves the field open for the discove- 
ry of more improved and accurate researches. 

* See an account of these experiments, contained in a letter to Dr. 
Mitchell, dated Port Royal, April 7, 17G8. Medical Repository, vol.2. 



Remote Causes of Fever, 21 



SECTION 4. 

Economy of Vegetation, and its relation to the Causes and 
Origin of Endemic Fever. 

It appear? from numerous and extensive observations that 
the principles of vegetation and the causes of fever are inti- 
mately connected, and so closely and inseparately allied as 
to render probability almost certain, that the sources and 
nature of the causes of both are analogous. We know that 
where the principles and requisites of a luxuriant vegeta- 
tion exist in the greatest abundance, there also fever, as an 
endemic, is apt to prevail. Heat and moisture are essen- 
tial to putrefaction, and the consequent production of veget- 
able growth. These circumstances are the most conspicu- 
ous in the low and marshy situations of hot and tropical cli- 
mate?, aTong the margins of rivers and creeks, and near ponds 
of stagnating water; in such places, also, endemic fever is 
a common occurrence; whilst, even in the same climate, 
where the country Is high and dry, and in hilly situations 
above the reach of inundation and the miasmata of the low 
grounds, swamps and water courses, fever as an endemic is 
scarcely known : much less in cold and northerly climates 
similarly situated with respect to elevation and dryness. — 
We may remark, however, that there are some low and 
marshy situations, which, abounding with an excess of the 
necessary ingredients, are, notwithstanding, covered with a 
stinted crop of vegetation : here the superabundant stimu- 
lus of nutrition, as in the animal kingdom, proves unfavora- 
ble to a healthy and vigorous growth ; whilst at the same 
time the light and spongy mould of which these marshes 
consist does not afford a foundation of sufficient firmness and 
solidity to admit of the support of large and luxuriant veget- 
ation. As in such instances the principles of vegetation 
which are evolved from this mass of corrupting materials 
are unappropriated to the growth of plants, they will float 
in the atmosphere, and show their deleterious effects upon 
such persons as live within the extent of their diffusion. 

Since the corrupting materials of the physical world af- 
ford food, nourishment and growth to living plants, it fol- 
lows, that provided vegetation is sufficient for the consump- 
tion of the products of animal and vegetable decomposition, 
the atmosphere will preserve its punty. Although places 
abounding with the requisites of a luxuriant vegetation are, 



22 Remote Causes of Fever, 

on that account, the least healthy, still the position general- 
ly holds true, that the more copious and luxuriant vegeta- 
tion is in any situation, the more healthy will that place be 
rendered : for the consumption of the gaseous results of an- 
imal and vegetable decomposition, upon which processes the 
insalubrity of the atmosphere depends, will purify the air in 
proportion to the quantity of these morbific materials ap- 
propriated to the growth of vegetable matter. We nave a 
striking and convincing proof of the pernicious influence of 
miasmatic emanations from corrupting substances, in the 
first settlement of towns and districts in a hitherto wild and 
uncultivated country, where the land is suddenly cleared of 
a flourishing and exuberant vegetation by which it was for- 
merly shaded ; and in the progress of cultivation an unusual 
quantity of vegetable mould is ploughed up and exposed to 
the action of the air and sun ; whilst at the same time, from 
the destruction of the trees, the country is deprived of the 
natural agents by which the accumulation of noxious exha- 
lations in the atmosphere was prevented. From this view 
of the subject, we may explain a fact of frequent observa- 
tion, that swamps and new lands are prevented from exert- 
ing any pernicious influence when planted with vegetables 
of rapid growth, as the sugar-cane, Indian corn, and other 
plants of quick and great luxuriance, which consume, and 
appropriate to their nourishment and increase, a large quan- 
tity of the putrefactive products. 

We are informed by Dr. Rush, in his account of the climate 
of Pennsylvania, of its being a well known fact, that inter- 
mittent and bilious fevers had increased in proportion as the 
country had been cleared of its wood in various parts of the 
state. And on the contrary, of its being equally certain, 
that these fevers diminished or disappeared in proportion 
as the country became cultivated.* 

In illustration of the circumstance, that vegetation con- 
duces to health, we are informed by Dr. Williamson, in his 
history on North Carolina, that families who live in the Dis- 
mal Swamps, without a perch of clear or dry ground, en- 
joy more health than people who live on their new planta- 
tions, near the rivers and swamps. He observes, that the 
bad effects of recent cultivation, by which decaying vegeta- 
bles are exposed to the sun, are severely felt in flat countries 
and warm climates. Carolina was less sickly before the 
country was opened. The second colony of adventurers 
remained twelve months in the country, and they lost only 

* Med. Inq. and Obs. vol. 1, p. 44. 



Remote Causes of Fever, 23 

five m^n out of one hundred and seven, though they were 
bad! v sheltered and suffered much from the scarcity of pro- 
visions. A gentleman in Craven county had lived on his 
farm about forty years without suffering by intermittent fe- 
vers, though liis family consisted of fifty cr sixty persons. 
There were about one hundred and fifty acres of cleared 
ground in front of his house that had been cultivated many 
5 ears, but a thick wood extended in the rear of his dwelling. 
In the beginning of the year 1785, he caused all the timber 
and shrubs that were behind his house, within four or five 
hundred yards, to be cut down : his object was pasture, and 
a free circulation of air. One third of his family, the next 
summer, were taken down by intermittent fever ; though 
such complaints were not more prevalent than usual during 
that summer, in other parts of the flat country. 

This fact is also illustrated by Dr. Scott, in his account of 
the fever of Gennessee county, in the state of New-York. 
We are informed that though the land, previously to its 
being cleared, was very moist, yet the first settlers were 
healthy ; but as the trees were removed, the inhabitants 
became subject to severe attacks of a very malignant fever, 
until the whole country became a scene of mortality, and 
many died vomiting black matter in the greatest extreme of 
anxiety and pain; while others would walk about, saying 
they were quite well, until within a few hours of their dis- 
solution. But after vegetation was established and had be- 
come general, the country was again rendered more heal- 
thy.* This subject will be further illustrated when we 
come to speak of the fevers of Alabama. 

That judicious and accurate observer, Dr. Robert Jack- 
son,! has remarked, that the rise and progress of endemic 
fever are evidently connected with the different periods of 
the season. In spring, the principle of vegetation is extri- 
cated in great quantity, while the capacities of plants are 
still small ; an excess is consequently generated, and this 
excess extends its influence to a certain distance around. 
In summer, the extrication of the principle still increases, 
but the capacities of plants having extended in a greater 
proportion, the means are more adequate, and the excess is 
actually less. In autumn, the growth of plants being com- 
pleted, while the causes still continue to produce a great 
extrication of the principle of vegetation, the excess abounds 
and escapes in a wider circle. 

* Med. Repository, Vol. X. 

t History and Core of Fever, chap, iii 1 , 



24 Remote Causes of Fever. 

It appears that the leaves of plants perform a function 
in their economy analogous to that which takes place in the 
lungs of animals and the gills of fishes; in other words, that 
the leaves are to vegetables, what the lungs are to the alii- 
rr.al creation ; and that the leaves may therefore be tailed 
the lungs of plants. During the spring of the year, previous 
to the developement of the leaves, and in .the early part of 
the cay, whilst the sensibility of the plant is greatest, the, 
sap rises by the stimulus of heat, through the alburnum or 
sap of the wood, and falls by the same vessels when the 
heat is withdrawn, or considerably diminished ; hence it 
happens, that if a tree be pierced at this period, ihe. sap ex- 
udes through the wound, because there is no other outlet. 
By the process of vegetation, however, a new channel of 
communication is opened, and the sap is now protruded 
onwards and circulates through the leaves, from which a 
copious transpiration takes place; and as the sap horn de- 
scends through the liber, or inner bark, the tree no longer 
bleeds. 

The alburnum, or what is called the sap of the wood, pass- 
ing from the branch is expanded through the parenchyma of 
the leaves, in the form of ribs and smaller vessels, through 
which the sap circulates. The leaf itself is covered with a 
cuticle or scarfskin, both on its upper and lower surface; 
the latter is supposed to absorb, and the former to transpiffe. 
As in the animal body, so the vessels of plants appear to 
have at least two terminations, one in transpiring, the other 
in returning vessels ;* by the former, the redundant and wa- 
tery part of the sap is exhaled in copious quantity, whilst the 
remainder, having undergone the necessary change, returns 
through the appropriate vessels of the leaves and bark, and 
is finally deposited in a pulpy state on the exterior surface 
of the alburnum, where, after being sufficiently inspissated 
and hardened, it forms a portion of the growing plant.f 

Various earthy and metallic substances are found to enter 
into the composition of plants ; and it is a matter of some 
doubt, whether these are formed denovo by the plant itself, 

* Besides this vascular structure of the leaf which has been noticed, it's 
bulk and colour are chieSy formed by a series of cell?, supplied, probably, 
by a third and distinct termination of the vessels which perform the Circu- 
lation of the crude sap. 

t These annual depositions of ligneous matter are very conspicuous in 
the chesnut and o'her trees of rapid growth and porous structure. By 
counting those concentric circles in the stump or body of a tree, its age 
may be ascertained. 



Remote Causes of Fever, 25 

or are absorbed in an attenuated and liquid form from the 
air and soil.* 

It was at one time supposed that growing plants gave 
out oxygen and absorbed carbonic acid, hut as the latter is 
always necessary for the production of the former, and as 
the quantity of the oxygen gas produced is exactly equal to 
the quantity of carbonic acid gas that i ; sappears, it seems 
that the oxygen gas is merely the result of the decomposi- 
tion of carbonic acid. The experiments of Sir Humphrey 
Davy, however, seem to prove, that when plants ere con- 
fined in an excess of carbonic acid gas, they possess the 
power of absorbing it to an unusual degree, rendering the 
air thus confined more pure than that of the external atmos- 
phere. From the experiments of Sir Humphrey Davy and 
Mr. Ellis, it appears that growing plants universally and un- 
der all circumstances consume oxygen and produce carbo- 
nic acid gas; and that the bulk of the acid gas produced is 
exactly equal to that of the oxygen consumed. This seems 
to contradict the plausible theory entertained by modern 
philosophers, that the carbonic acid gas evolved by combus- 
tion and animal respiration, is consumed by the growing 
plants; and that the process of vegetation thus counteracts 
the adulterating effects upon the atmosphere of respiration 
and combustion. 

It was observed by Sir Humphrey Davy, that in the dark 
no oxygen gas is produced by plants, whatever be the elas- 
tic medium to which they are exposed, and no carbonic acid 

* From the following interesting account by M. Henri Bracconnot, (An- 
nates de Chernie'i Fev. et Mars, ilHGS,) we should be inclined to the pre- 
sumption that plants possess the power oi forming denovo the various earths 
and metals found in their composition. 

Seeds of various plants were sown in pure river sand, in litharge, in flow- 
ers of sulphur, and even among metal, or common leaden shot ; and in ev- 
ery instance nothing employed for their nourishment but distilled water. 
The plants throve, and passed through all the usual gradations of growth 
to perfect maturity. The author then proceeded to gather the entire pro- 
duce, the roots, stems, leaves, pods, seeds, &c. These were accurately 
weighed, dried, and again weighed, then submitted to distillation, incinera- 
tion, lixivation, and the other ordinary means useful in a careful analysis. 
Thus he obtained from these vegetables all the materials peculiar to each 
individual species, precisely hs if it had been cultivated in a natural soil, 
viz. the various earths, the alkalies, acids, metals, carbon, sulphur, phos- 
phorus, nitrogen, &c. He concludes this very important paper nearly in 
these extraordinary words : '• Oxygen and hydrogen, with the assistance of 
solar light, appear to be the only elementary substances employed in the 
constitution of the whole universe; and Nature, in her simple progress, 
works the most infinitely diversified effects by the slightest modifications in 
the means she employs." ' See " Recherches sur la force Assimilatricc dans 
les Vegetaux, par M. Henri Braeormot, 1 ' as quoted by Parkes. Chan. G»(- 
tchism, p. 495. 



26 Remote Causes of Fever, 

gas is absorbed. In most instances, on the contrary, oxygea 
gas, if it be present, is absorbed, and carbonic acid gas is 
produced. " I once supposed," he adds, " that ail the car- 
bonic acid gas produced by plants in the night or shade, 
might be owing to the decay of some part of the leaf, or epi- 
dermis ; but the recent experiments of Mr. Ellis are opposed 
to this idea; and I found that a perfectly healthy plant of 
celery, placed in a given portion of air, for a few hours on- 
ly, occasioned a production of carbonic acid gas, and an ab- 
sorption of oxygen.' 7 Mr. Davy thinks, however, that upon 
the whole, the balance is in favor of amelioration of the at- 
mosphere from the process of vegetation. We know that 
most of the metals, and many of the earths, have a strong 
tendency to combine with carbonic acid -.whether the con- 
sumption in this way is equivalent to its production by res- 
piration and combustion? I do not [eel myself authorized to 
determine, though the supposition appears probable. Be 
this as it may, carbonic acid gas is probably never, in any 
degree, the cause of endemic (ever. The inhabitants of 
many cities are daily in the habit of taking large quantities 
of it into the stomach, in the different preparations of aerated 
or soda waters, without experiencing the least injurious ef- 
fects. It is also exhibited with advantage in fever itself; 
and it has been found that in warm climates pestilential fe- 
vers abate during the vintage ; which circumstance has been 
ascribed to the fermentation and consequent evolution of 
carbonic acid. 

Though the decomposition of carbonic acid by growing 
plants, was the only or principal manner in which the pre- 
vention of an excessive accumulation of this gas could be 
accounted for, yet there may be some secret process, left 
for the discovery of some future philosopher, by which this 
circumstance may be satisfactorily explained. 

It would seem, since water forms such an essential requi- 
site in the growth of plants, that they possess the power of 
decomposing it, and of appropriating the hydrogen to their 
own nourishment and growth. This would appear more 
especially the case in aquatic plants, and the variety of sea 
weeds, which seem to draw their sustenance almost exclu- 
sively from the water alone. Besides, we know that plants, 
by their vegetation and decay, have the property of fertilizing 
the soil, and that plaster (gypsum) and other mineral sub- 
stances act merely by increasing the power of absorption in 
the growing plants. Hydrogen, one of the elementary prin- 
ciples of water, forms a very important part of vegetable 
matter; it is by the combination and consolidation of this 



Remote Causes of Fever, 2? 

clement with the carbon of (he atmosphere and a portion of 
the oxygen, that are formed the vegetable oils, wax, gums, 
resin, sugar, and finally the wood and solid fabric of the plant 
and tree; the residue of the unappropriated oxygen of the 
water is returned to the atmosphere to purify and enrich it. 
Plants, likewise, have been made to grow in sand, and after 
having come to maturity, the sand, upon being dried and 
weighed, was not found to have sustained any diminution; 
so that the substance of the plant must have been derived 
from the water with which it was nourished, and from the 
atmosphere.* 

Whatever may be the function of the leaves, there can 
be no doubt that the principal part of the nourishment of 
vegetables is taken in by the root. The elastic matters that 
escape from animal and vegetable manures, principally con- 
sist of carbonic acid, hydro-carbonate and ammonia; and 
as vegetable substances are composed chiefly of hydrogen 
and carbon, the materials which furnish these elements are 
essentially conducive to fertility and vegetation. Nitrogen 
is also favorable to the growth of plants which grow and 
flourish freely in this gas. Since these substances are ab- 
sorbed by growing plants from decomposing matter, whether 
these are taken in by the leaves or root, the effect in pre- 
venting the deleterious operation of noxious exhalations will 
be the same. 

One striking peculiarity of hot and tropical climates is, 
the vast luxuriance of the vegetable world, and the countless 
myriads of animated beings. All nature teems with life. 
Wherever the land is fertile, but especially on the rivers 
and water courses, the oak, the poplar, the ash, the gum, 
the lynn, the sycamore, the hickory, &c. uniting their 
branches, make a dense shade, impenetrable to the noon- 
day sun : in addition to which, the variety of vines, shrub- 
bery and undergrowth, form a matted thicket, in many 
places almost impassable to the wild beasts which they 
shelter and protect. The plants of the season wither and 
die with the cold of winter, but no sooner does spring recal 
the warm and genial breezes of the south, than nature starts 
into renovated bloom and verdure : mounting the loftiest 
trees, the vines, which lately appeared like the ropes and 
cordage of a navy, soon cover the woods with their luxuri- 

* In proof that fishes possess the same power of decomposing water and 
of applying it to their own nourishment, we read of a fish that was kept 
three years in a vessel of water, which element was its only food ; the fish 
at last hecame too large to live any longer ia the vessel. (Rondelet it 
Piscibus, lib. i. cap. 12.) 



28 Remote Causes of Fever, 

ant foliage ; (he lawns and opening vistas of the forest are 
closed and obstructed to the searching eye. A deep and 
melancholy gloom gives an aspect of solemnity and awe to 
the groves and uncultivated wilds. Not a foot of ground 
is left unoccupied, the spaces afforded by the larger trees 
are filled up by those of smaller growth ; and vines, 
bushes, briars, weeds, and shrubbery of ditFerent descrip- 
tions contend for the remainder: to all which, add the 
swarms and multitudes of flies, musquetoes. bugs and small- 
er insects which find a continent in every leaf, lizards, rep- 
tiles, beasts, birds and smaller animals which seek the 
shady covert of the woods, and some idea may be conceived 
of the prolific nature of a southern clime. 

It is to this luxuriance of vegetation and this countless 
number of insects and animated beings, which annually 
perish and decay, infecting the air with their morbific ema- 
nations, that we may ascribe, in a considerable degree, the 
origin and prevalence of endemic fevers. 

The evening air, in this climate, in all damp and shady 
places* is generally impregnated with «ome palpable odour. 
The most disagreeable, is that of ponds and marshes, where 
the water has been recently dried up ; the smell is old and 
musty, with a considerable degree of foetor; the next in 
degree of strength, is the musky smell of the banks of small 
streams, reed brakes and wet places ; the odour, though 
strong, is not unpleasant, except to those whose olfactories 
are very delicate; the scent approaches nearer to that of 
musk than any other. The next, and faintest in degree, is 
a peculiar aroma, as if composed of musk and spices ; it is 
mostly perceived in the vallies of a sandy soil, upon a cool 
and still evening succeeding a hot day. Besides these odouri 
there are others less frequently observed, which are more 
or legs disagreeable, but which do not admit of a description. 
One remark which i would make is, that the unpleasant 
odours appear to be nearly allied to the agreeable in their 
proximate principles. 

Upon the subject of decomposition as applicable to ma- 
nures, Sir Humphrey Davy, in his lectures on agricultural 
chemistry, has some useful observations. " The doctrine 
of the proper application of manures from organized sub- 
stances,'" says Sir Humphrey, " offers an illustration of the 
economy of nature, and of the happy order in which it is 
arranged. The death and decay of animal substances tend to 
resolve organized forms into chemical constituents, and the 
pernicious effluvia discharged in the process, seem to point 
out the propriety of burying them in the soil, where they 



Remote Causes of Fever, 29 

are fitted to become the food of vegetables; The fermen- 
tation and putrefaction of organized substances, in the free 
atmosphere, are noxious processes; beneath the surface of 
the ground they are salutary operations. In this case, the 
food of tb^ plant i* prepared where it can be used ; and that 
which would offend the senses, and injure the health if ex- 
p ed, is converted by gradual processes, into forms of beauty 
and usefulness: the foetid gas is rendered a constituent of 
the aroma of flowers ; and what might be poison, becomes 
nourishment to animals and to man." 

It is thus that provision has been made for the regenera- 
tion of the fallen leaves, which lie scattered, and rot upon 
the ground, and which, to ordinary observation, would ap- 
pear to be lost for ever. It appears from the experiment of 
Berth' liet, whenever the soil becomes charged with the de- 
caying and corruptible materials of animal and vegetable 
growth, the oxygen of the atmosphere combines with the 
mouldering mass, and converts it into carbonic acid gas, the 
food and nourishment of growing plants. 

In this manner it is that, by the products of putrefaction, 
the animal and vegetable creations are renewed. Nothing 
is lost by death : it is but a change of condition, a transmu- 
tation of matter. From the mouldering ruins of departed 
life, a new growth arises into existence, with all the grace 
and beauty of renovated youth; and thus the metempsy- 
chosis of animal and vegetable beings, as likewise the ancient 
fable of the phenix emerging into life from her parental 
ashes, is chemically true. 

Thus when a monarch or a mushroom dies, 
Awhile extinct the organic mattpr lies ; 
But as a tew short hours or years revolve, 
Alchymic powers the changing mass dissolve; 
Emerging matter from the giave returns, 
Feels new desires, with new sensation burns; 
With youth's first bloom a finer serree acquires, 
And Loves and Pleasures fan the rising fires. 

Darwin. 

Organic forms with chemic changes strive 
Live but to die, and die but to revive ; 
Immortal matter braves the transient storm, 
Mounts from the wreck, unchanging but in form. 



30 Remote Causes of Fever. 

SECTION 5. 

Of Heat and Moisture. 

Some physicians, overlooking the more immediate causes 
©f diseases, have entertained the idea that the heat of sum- 
mer in hot and tropical climates, was alone concerned in the 
production of endemic fever. Whereas the on!y influence 
which the heat of climate and season can have upon the 
constitution, in aiding the influence of miasmata, is to pro- 
duce debility, thereby rendering the body more susceptible 
of disease; or. in other words, acting as the predisposing 
cause of fever. " The heat of tropical climates," says Dr. 
Kunter, " though generally represented as the cause of their 
unhealthiness, will not alone produce fevers, as is strikingly 
exemplified in those living on board of ships, who remain 
free from fevers; and algo, the inhabitants of dry sandy 
spots along the coast, in which the heat is unusually great, yet 
the situations are healthy, as Fort Augusta, Port Royal, and 
others.-''" In order to produce endemic fever, it is neces- 
sary that the heat should have corruptible matter to act up- 
on, and that this corruptible matter be in a state of humidi- 
ty, '" It is commonly asserted, 5 ' says Assalini,f " that the 
heat, in Egypt, puts a stop to the plague, whilst it makes it 
"break out in Constantinople. How is this fact, 59 continues 
he, " to be accounted for? The explanation, in my opinion, 
is very simple. At Constantinople, the exhalations from 
various bodies, in a state of putrefaction, are very copious 
during summer; the cold of winter prevents their formation, 
and the disease ceases. In Egypt, on the contrary, the 
action of the sun is \ery powerful, even during winter, and 
gives rise to noxious exhalations. When the low grounds 
have become dry, which happens in the month of Nisidor, 
(in June, at the festival of St. John) then the coast of Lower 
Egypt becomes as healthy as the rest of that fine country." 

It is remarked by the natives on the coast of Coromandel, 
and the observation is confirmed by the experience of many 
Europeans, that the longer the hot land winds continue to 
"blow, the healthier are the succeeding months ; agreeably 
to their opinion, these winds purify the air. The inquiry 
is made by Dr. Lind, whether these winds are not the cause 
why the air on the coast of Coromandel, except during their 

* Diseases of Jamaica, p. 16. 

t Assalini on the Plague, American Edition, p, 12. 



Remote Causes of Fever. 31 

continuance, is more healthy than in other parts of India* 
where these winds do not blow ; and whether this does not 
suggest a very probable reason why the plague in Egypt 
generally ceases in the beginning of June: the periodit al 
hot winds that come from the deserts of Nubia and Ethio- 
pia, having then rendered the air in Egypt pure and whole- 
some.* This effect of the hot wind seems to be owing to 
the sudden and rapid exsiccation which it occasions, depriv- 
ing the decaying remains of animal and vegetable matter 
of their moisture, and thereby suspending the process of pu- 
trefaction : another, and perhaps considerable effect, seems 
to be its power of rarifying, by the degree of heat which 
accompanies it, the noxious miasmata themselves.! 

The fact of the hot winds, as they are properly called, put* 
ting a stop to the plague in Egypt, is confirmed by the gener- 
ality of travellers, who have made observations upon the 
subject.]: After the 24th of June, the plague, however 
great may have been its ravages, ceases in Egypt. After 
that day, there is seldom an instance of any person being 
attacked by that disorder. Some have attributed this to 
the overflowing of the Nile, others to the prevalence of the 
north wind ; but it is pretty clearly ascertained, that the 
plague generally ceases before any increase of the Nile is 
perceptible, and before the commencement of the north 
wind. And Mr. Antes has shown from authentic facts, that 
any extraordinary degree of heat, even at an earlier sea- 
son, produces a similar effect. 

Different from this; however, is a hot, close, stagnating 
air, not agitated or refreshed by breezes and gusts of wind ; 
and which, by debilitating and relaxing the system, must act 
as a predisposing cause, and by favoring the accumulation 
of infectious miasmata, must contribute to increase the 
vitiated state of the atmosphere : for where the putrefaction 
is of a local nature, a strong breeze, by displacing and re- 
moving the infected atmosphere, for a time renders it 
healthy, until again corrupted by the original source of de- 
composition. 

Hippocrates, in describing a pestilential fever, says the 
year in which it prevailed, was without a breeze. A similar 
state of the atmosphere existed during the prevalence of 
the plague in London in 1665. We are informed that du- 

* Lindonthe Diseases of Hot Climates, p. 4?. 

t The injurious and sickening effect of this wind, during its continuance, 
is to be attributed to the circumstances already mentioned, its constrictia* 
the skin, and checking perspiration. 

$ Antes' Observations, p. 45. Brown's Travels, p. 369. 



32 Remote Causes of Fever. 

ring a plague at Vienna* the wind did not blow for three 
months; at the end of this time, a breeze arose, by which 
the distemper was evidently alleviated.* We are told by 
Dr. Clark, that sailors become sickly after long calms in 
East India voyages. Sir John Pririgle observes, that "when 
the heats come on soon, and continue throughout autumn, 
not moderated by winds or rains, the season proves sickly, 
distempers appear early, and are dangerous. This hot, 
stagnating and oppressive state of the atmosphere, is also 
taken notice of by Dr. Rush, as attending the mortality of 
the yellow fever in Philadelphia in 1793. 

Gusts of wind and showers of rain have considerable in- 
fluence in purifying the atmosphere, by precipitating and 
dispersing the noxious miasmata, and thereby giving a check 
to the rise and prevalence of disease. This was pancu- 
larly remarkable in different par's of Alabama, in the urn- 
merof 182.3. There were but very few days successively^ 
in which there were not one or two copious showers of rain, 
accompanied with loud peals of thunder, and heavy gusts 
of wind. The extinct relics of animal and vegetable 
growth had scarcely time to commence decomposition be- 
fore they were swept away by a flood of rain, and the nox- 
ious miasmata attaching themselves to the drops and parti- 
cles of water, were carried off in the common deluge. 
Sometimes, for three or four days successively, the face of 
the sun would be scarcely visible tor a moment. The Ala- 
bama river was almost constantly swollen, and had a depth of 
water sufficient for the largest steam- boats ; a thing unusual 
at that season of the year. The consequence was, that the 
summer and autumn proved remarkably healthy. Di\ 
Rush, on the subject of the yellow fever of 1795, observes, 
that ''On the 30th and 3lst of August, there was a fall of 
rain, which suddenly checked the fever of the season, inso- 
much, that the succeeding autumnal months were uncom- 
monly healthy."! The same thing took piace in the fever of 
1796, in consequence of the rain which fell about the mid- 
dle of July, so that August, September and October, were 
nearly exempt from disease. J 

It appears from the register of interments in the Friends' 
burying ground, that the yellow fever which raged in Phila- 
delphia in 1699, and which is taken notice of in the Journal 
of Thomas Story, ceased about the latter end of October, 



* Van Swieten's Comment. 

t Inquiries and Observations, Vol. Ill, p. 44Q. 

X Ibid. 



Remote Causes of Fever: 33 

$r the beginning of November. The same disease wai 
checked by wet and cold weather in the year 1741. 

As to the degree of temperature necessary to the origin 
and prevalence of the bilious endemic or yellow fever, the 
following facts are adduced in illustration. 

Dr. Le Blond, in his observations on the yellow fever, as 
it fell under- his notice in America, between the 15° of north, 
and the 15° of south latitude, represents the temperature 
of the hot or low country, situated near the sea coast, as be- 
ing in the day marked from 82, to 100, of Fahrenheit, and 
in the night from 73 to 68. 

Dr. George Davidson, in his observations on the yellow 
fever of Fort Royal, Martinique, informs us, that towards 
the latter end of June, the thermometer, in the shade, stood 
for several days at 90° of Fahrenheit, at 2, P. M. ; which 
proved a prelude to the appearance of the disease. " I have 
no doubt," sa)s he, "when the mercury stands at 86°, or 
above that for several days, the weather being at the same 
time calm, that exhalations from swamps, and miasmata from 
putrid vegetable and animal matter, chiefly, are capable of 
producing the disease."* 

Dr. Richard Bailey, on the subject of the yellow fever of 
New- York, in the years 1796, '97, and '98, gives the fol- 
lowing thermometrical statement of the weather.! 

On the 8th of August, 1798, the mercury in Fahrenheit's 
thermometer, at an elevation of forty feet above the ground 
and in the shade, at 2, P. M. stood at 91°* 

On the 9th, 96°, On the 12th, 86°, 

10th, 90, 13th, 83. 

11th, 89, 
The highest to which the mercury rose in 

July, 1795, was 83°, July, 1797, was 90°, 

August, 95, August, 82, 

July, 1796, 88, July, 1798, 94, 

August, 89, August, 96 

After the immense fill of rain on the 1 4th of August, 1 798, 

which tilled many cellars in the lower parts of the city, and 

occasioned a quantity of standing water, the thermometer, 

which had fallen on that day to 78, rose on the 

15th, to 82, 17th, to 90, 

16th, 85, 18th, 90. 

* Letter from Dr. Geo Davidson, dated Fort Royal, Martinique, Sept. 
20, 1796, to James Mease, M D. resident physician of tke port of 'Philadel- 
phia. Med. Repos. Vol. I. p. 157. 

1- See Med. Repos Vol. II. p. 285. 

E 



34 Remote Causes of Fever. 

This sudden and great increase of heat, our author informs 
us, immediately after the violent rain, appeared to have a 
proportionate influence in producing fever : and that from 
this period, the disease became more genera!. The great- 
er fatality of the fever in 1798, Dr. Bailey ascribes to I he 
greater degree of heat, moisture, and corruptible materials ; 
and the fever was particularly severe in Cliff street, Cathe- 
rine slip, Water street, Burling and Beekmar slips, where, 
in addition to the offensive accumulations of offa is, garbage, 
the refuse of vessels, kitchens, and other impurities deposi- 
ted in the slips and gutters, there was an enormous quantity 
of spoiled beef, fish, and other articles of a perishable na- 
ture, the stench from which was extremely offensive. Du- 
ring the prevalence of an easterly wind, and after its con- 
tinuance for forty-eight hours, there was scarcely a house 
in Pearl street, near where the spoiled provisions were sto- 
red, in the lower end of John street, and in Ci iff street, 
which was not visited by the fever. 

The bilious or yellow fever prevailed in Boston, from the 
18th of June, 1798, to the 29th of October* The disease 
prevailed principally in the neighborhood of filthy and offen- 
sive docks, sewers, and confined narrow, dirty lanes, and in 
the vicinity of a mill pond, the receptacle and deposit of all 
manner of filth, as dead dogs, cats, putrid meat, fish, and rot- 
ten vegetables. 

The thermometer in June ranged for twenty days from 
70 to 83, and nine days from 69 to 70. The diseases this 
month were fevers, pleurisy, bilious and inflammatory fe- 
vers, opthalmia. and a few cases of cynanche parotidea. 

During the month of July, the range of the thermometer 
was from 72 to 96, excepting three days, when it descended 
to 67. The diseases this month were the typhus gravior, 
and in some instances the yellow fever. 

In the month of August, the mercury fluctuated between 
72 and 94, except on the 20th and 23d, when it fell to 69 
and 67. 

During the month of September, the thermometer va- 
ried from £6 to 77. On the 29th, there was a frost; and 
the fever abated towards the latter end of the month. 

In the month of October, the thermometer ranged from 
36 to 5Q. For thirteen days, the wind was from the N. W. ; 
for the remainder of the month, it was variable from N. E. 
to S. E. On the 7th, there was a great storm, with much 

* See an account of the epidemic prevalent in Boston, by Isaac Ranel. 
Med. Kepos. Vol. H. 



Remote Causes of Fever* 3i> 

rain. A severe frost happened on the 29th, when the fur- 
ther progress of the fever was arrested. 

The remitting, bilious, or yellow fever, which prevailed 
at Wilmington, (Del.) in the summer and autumn of 1800, 
was preceded by cynanche maligna, parotidea, and by diar- 
rhoeas, choleras, and dy?enterie*. There was a great ten- 
dency to inflammatory affections, especially in cases of local 
injuries which were liable to run into gangrene. During 
the month of July, the thermometer ranged from 85 to 91°, 
with occasional thunder gusts throughout the month. 

During the nionth of August, the thermometer ranged 
from 73 to 85, and on the first of the month the mercury 
stood at 91°.* 

We are informed by D»s. Selden and Whitfield, that du- 
ring the prevalence of the yellow or bilious fever in Nor- 
folk, (Va.) in 1800, after the 25! h of June, the inhabitants 
for two months lived in an atmosphere heated above the 
85° of Fahrenheit's thermometer, sometimes to 94 or 95, 
anJ very frequently upwards of 90. The rains had been 
very frequent in June and July; but instead of cooling the 
atmosphere, it was observed that they were followed by 
more intense heat. The disease disappeared towards the 
latter end of October, upon the setting in of cool weather. f 

Providence, (R. I.) was visited by the yellow fever in 
the -ears 1797, 1800, and 1805. The disease appeared in 
th . v >>t confined, warmest, and most filthy parts of the town ; 
in the south part of Water street, and the lanes and alleys 
adjacent, opening to the wharves, which are filled in with 
earth, logs, oyster shells, &c. having vacuities through which 
the tide ebbs and flows. The docks are very flat, and are 
left partially bare at low water. The yellow fever made its 
appearance there in 1797, on the 13th of August; in the 
first part of this month, damp easterly weather had been 
succeeded by a sudden transition of heat, when the ther- 
mometer, in an airy situation, ranged from 86 to 91 of Fah- 
renheit. J 

The bilious remitting fever prevailed in Savannah in 
1805, as it has on several other occasions, and carried off 
175 white persons, out of a population of little more than 
2,000. According to Dr. White, the following were the state 
of the thermometer and weather this season. 

* See an Account of the Diseases at Wilmington, (Del ) in the Summer 
and Autumn of 1800, by Dr. John Vaughan. 

t Med Repos. Vol IV. p. 329. 

X Wheaton's Account of the Yellow Fever in Providence. Med. Rep. 
Vol. X. p. 329. 



38 Remote Causes of Fever. 

June was cool, with much rain. Three days the mercury 
rose to 90 and 91° : for the rest, it varied from 77 to 82°, 
during the heat of the day. 

Julv was hot and dry. The mercury rose to 93 twice, 
once to 92. and three times to 91. 

In August, (wo days the mercury rose to 90 and 91, for 
the rest from 81 to 90, at the hottest period of the twenty- 
four hours. Eighteen days were more or less rainy. 

September was cooler than usual for the climate. On 
the 14th, the mercury was at 88° at 3, P.M. During the 
rest of the month, it ranged between 72 and 85. Twelve 
days were rainy. 

The sickness arrived at its height in September, declined 
in October, and disappeared in November.* 

Don Armasto wrote an eloquent and interesting pamphlet 
on ihe plague, or bilious fever of Cadiz in 1800. With this 
pamphlet I have merely obtained a slight acquaintance, 
through the medium of the Medical Repository. In the re- 
view, one of the most material parts of the work, the meteo- 
rological observations are omitted. We are told, however, 
that the weather was unusually hot during this sickly period, 
and that the thermometer rose to 95°, a degree of heat un- 
usual in those latitudes, equal to that of Senegal, and greater 
than that of the equatorial continent of America. In the 
rays of the sun, and in damp places, the mercury often rose 
to 1 1 2°. The winter rains having heen protracted one month 
later during the spring, the moisture was as excessive as it 
ever has been observed in countries subject to pestilence. 
In fine, forty days of the most distressing easterly wind, 
highly predisposed every living body to disease.! 

Dr. Joseph Johnson, in his account of the diseases of 
Charleston in 1793, makes the following observations upon 
the weather which ushered in and attended the bilious re- 
mitting or yellow fever of that season, after remaiking that 
the approach of summer was as rapid as the spring had been 
backward, he observes, " The 1 1th of June was one of the 
hottest days to which our chmate is subject; the thermom- 
eter standing at 92°, in a very cool situation, and at 94° gen- 
erally through the city. The average heat of July was 86° ; 
a range considerably higher than had been observed since 
1796, and somewhat exceeded the great heat of that year. 
From the 26th of July to the 18th of August, there had been 
but one shower ; the heat being steady and considerable, the 



* Med. Repos Vol. II. p. 12. 
f Ibid, Vol. XL p. 137. 



Remote Causes of Feter. 37 

enrfemial cansus commenced about the latter date, and was 
aggravated by the extremely hot weather, from the first to 
the fifth of September, when the thermometer, at noon, in 
the coolest situation, varied from 90* to 92 J-. September 
was, from sickness and death, the blackest month ever re- 
corded in Charleston, there having been 328 interments, of 
which 114 were from endemial causus; and at least one 
Fourth of the inhabitants were affected with the influenza, 
about the last of the month. '' The remainder of the season 
was remarkable for the severity of the drought, so that many 
cattle died for want of water, and travellers could not obtain 
a sufficiency near the roads, either for themselves or their 
horses.* 

Dr. Caldwell, in his essay on the yellow fever of Phila- 
delphia in 1805, by a reference to a journal of the weather, 
kept for several years in that city, proves the coincidence 
between hot summers and the prevalence of the yellow 

Dr. Frost, in his account of the death of Dr. Valli, of 
yellow fever, at Havana,! in September, 1816, observes, 
that the thermometer ranged in the day from 81 to 85 of 
Fahrenheit, and never below 81, even at night. 

A malignant bilious fever appeared in July, in Winches- 
ter. Virginia, | in 1804. We have no regular register of 
the weather, but are told, that from the 15th of May nearly 
to July, there was more or less rain every day, with wind 
mostly from the S. E. ; the mercury in Fahrenheit's ther- 
mometer ranging from 6Q to 84 and 86. From the begin- 
ning of July to the 13th, the weather was very warm, with 
occasional heavy showers ; but from the 15th to the 22d, 
the weather was fair, and extremely hot, the mercury rising 
to 94 and 96. 

la the island of Jamaica, the heat at Kingston throughout 
the year varies from 70 to 80° of Fahrenheit. In ascend- 
ing towards the mountains, the temperature quickly alters 

* Med. Repop. Vol. XI. p. 402. From 1700 to 1748, "the yellow fever 
rag;ed at five different periods in Charleston. For forty-four years after 
that period, thf re was no epidemic prevalence of the direase, though it 
appeared in different summer? in a few sporadic eases. A new era of this 
fever commenced in the year 179.2. It raged in Charleston in that year, 
and in 1794, '95, '96, '97, '99, 1800, '1, '2, '4 and 7. The number of 
victims in the most fatal years, were, in 1799, 239; in 1800, 184; in 1802, 
96; in 1804, 148; in 1807, 162; in 1793, 98. It prevails from July to No- 
vember, but is mo^t epidemic in August and September. 

t Ibid, Vol. VIII. p. 252. Winchester is situated in 39° N. Lat. 

% Ibid, Vol. XVIII. p. 369. 



38 Remote Causes of Fever, 

with the elevation ; eight miles from Kingston the maximum 
is only 70 -; at the distance of four miles from this town, 
where the elevation is 4200 feet, the average range of the 
thermometer is from 47 at sun-rise, to 58 at noon ; and the 
minimum in winter is 42.* 

In the island of Java, from the month of July to Novem- 
ber, the thermometer on the coast generally ranges between 
80 and 90 during the hottest time of the day; and during 
the coolest part of the morning, is seldom lower than 88, 
In ascending towards the high grounds, the warmth of the 
atmosphere gradually diminishes from 85°, the ordinary heat 
in the plain, to 50°, the temperature experienced on the 
summit of the mountains, which are even occasionally cover- 
ed with snow. In the highest parts that are cultivated, the 
heat during the day is from 60 to 65°, and at night as low a3 
54°. The climate on the coast, and especially at Bantam, 
is more pernicious to the health of Europeans than that of 
any other country where settlements have been formed. — 
Of persons newly arrived, the usual calculation is, that three 
in five will die the first year, and of the survivors from nine 
to twelve in the hundred, annually ; exclusive of the troops 
and seamen, among whom, in consequence of their irregu- 
larities, the mortality is truly deplorable.! 

In India, the temperature of the coast of Coromandel is 
generally much higher than that of the provinces on the 
coast of Malabar; and the Carnatic and the north west ex- 
tremity of the northern Circars are deemed the hottest, not 
only on the Coromandel coast, but m ail India. In the lat- 
ter district, the French, m the year 1757, lost seven Euro- 
pean soldiers in the course of a single day by coup de sol/el. 
Along the sandy and almost dry bed of the Kri^hnah. the 
temperature is most oppressive; the thermometer being 
sometimes raised, near the mouth of that river, to 110° for 
several days, even in the house, and seldom falling under 
105. In the low country of the Arcot district of Carnatic, 
during the hot season, the thermometer, under the corner 
of a tent, rises to 100°, and, when exposed to the *un, to 
120°. Taking the average of the whole year, the heat of 
Madras is loss than that of Calcutta. In January, the ther- 
mometer is about 70°; this is the lowest temperature : the 
highest is in July, when the thermometer is about 9i°4. 

* Edinb. Encyclop. Art. Jamaica. 
t Ibid, Art. Java. 
| Ibid, Art. India, 



Remote Cause.* of Fever, 39 

The following state of the thermometer was observed in 
1801, in Demarara, by Dr. Chisholm,* where the yellow fe- 
ver generally prevails. In January, it ranged from 82 to 
84°. In February, from 76 to 83. In March, from 80 to 
86. In July, from 80 to 87. In August,,from 78 to 80. In 
September and October, from 86 to 88. 

In South Carolina, from 1791 to 1808, the difference be- 
tween the coolest and the warmest summers, was from 88 
to 93°, and the difference between themildesr and the cold- 
est winters, on a few particular days, from 50 to 17°. In 
Charleston and the low country, the heat is more moderate 
than in the interior parts of the state. At Columbia, in the 
summer of 1 808. the mercury in the thermometer frequent- 
ly rose to 96, 97. and sometimes to 98, whilst at Charleston 
it did not exceed 91°. The medium temperature of well 
water in Charleston is 65°, twelve degrees above that of 
well water in Philadelphia. 

It is remarked by Dr. Biain, that in order to produce yel- 
low fever, there must be, for a length of time, a heat sel- 
dom falling below 75° of Fahrenheit's thermometer. t 

From the result of observations upon the degrees of heat 
in Philadelphia in June and July, between the years 1793 
and 1809, collected and published by Mr. Evans, in the 
True American, of the 2d of August of 1809, it appears, 
that the yellow fever has never been epidemic in Philadel- 
phia, when the medium heat of June and July was below 
79°, except in 1802, when it was 78, and in which year not 
more than two hundred persons were supposed to have di?.d 
of it. Though fevers of inferior grades prevailed at a low- 
er temperature. J 

From all that has been a ,TT anced in relation to this sub- 
ject, I think it will appear that a range of temperature from 
70 to 86 of Fahrenheit is necessary to the production of the 
bilious endemic, or yellow fever; that the temperature 
should not fall much, if any, short of 70 at night, nor of 86 
in the heat of the day. But it may be remarked, that the 
higher the natural temperature of (he atmosphere, provided 
it is not sufficient to dissipate moisture, the greater the pu- 
trefaction, and the more sickly the season ; always bearing 
in mind, however, that a greater degree of heat will com- 
pensate for a deficiency of corruptible materials, and an ex- 

* See Edinb. Encyclop. Art. Cotton. 

f Diseases of Seamen, p. 425. 

% See Rush's Iuq. and Obs. Vol. IV. p. 16S. 



4$ Remote Causes of Fever. 

cess and abundance of the latter will be equivalent to a 
greater degree of the former. 

As to moisture, its only effect upon the body, when ex- 
ternally applied, seems to be that of aiding the operation of 
cold in stopping the pores of the skin, thereby checking 
perspiration, and suspending the excretion of offensive mat- 
ters from the mass of blood. It would be trifling and absurd 
to attribute to it any directly deleterious property ; since 
moisture, in the form of water, is one of the most essential 
requisites of life, as well in the animal as in the vegetable? 
kingdom. We daily consume, without the least apprehen- 
sion, a large quantity of this article; and so far from produ- 
cing disease, it is one of the most necessary preservatives of 
health, without which, man soon sickens, languishes and 
dies. '* Simple moisture alone," says Dr. Hunter, " is 
harmless, at least as far as relates to the production of fe- 
vers, of which Fort Augusta and Port Royal may be given 
as examples, for they are nearly surrounded with water on 
all sides."* 

That it is the miasmata, and not the moisture of particular 
situations, as some have contended, which occasion (aver, 
we have shown from the observations of Dr. Lind, confirm- 
ed by those of other physicians, that ships lying at anchor at 
a considerable distance from a sandy shore though envelo- 
ped in fog, escape intermittents ; whilst others lying near 
are subject to them. 

Dr. Franklin, in a letter to Dr. Percival, makes the fol- 
lowing sensible observations: " The gentry of England," 
says the Doctor, "are remarkably afraid of moisture and of 
air. But seamen who live in perfectly moist air, are always 
healthy if they have good provisions. The inhabitants of 
Bermudas, St. Helena, and other islands, far from conti- 
nents, surrounded with rocks, against which the waves con- 
tinually dashing fill the air with spray and vapour, and where 
no wind can arise that does not pass over much sea, and of 
course brings much moisture, are remarkably healthy. And 
] have long thought that mere moist air has no ill effect on 
the constitution; though air impregnated with vapor from 
putrid marshes is found pernicious, not from its moisture 
but putridity. It seems strange that a man, whose body is 
composed in a great part of moist fluids, whose blood and 
juices are so watery, who can swallow quantities of water 
and smalt beer daily without inconvenience, should fancy 

* Disease? of Jamaica. See also the Med. Transactions, v©l. viii. p. 521; 
for a continuation of the same opinion. 



Remote Causes of Fever, 41 

that a little more or less moisture in the air should be of 
such importance."* 

If moisture alone were capable of producing fever, sailors 
and sea-faring people would be peculiarly subject to it; for 
at sea the evaporation is veiy great, and the air is constantly 
Charged with moisture, so that cotton bales and other arti- 
cles soon acquire a considerable increase of weight; yet 
provided the provisions are vtholesome, and the vessel is 
kept clean and sweet, no situation is more healthy. 

We have already noticed the necessity of moisture as a 
means and requisite of putrefaction ; to this purpose, we are 
informed by Dr. Hunterf that the dry part of the country 
in the island of Jamaica continues healthy during the hot 
weather, but as soon as the rain sets in, it becomes unheal- 
thy. After heavy falls of rain, every part of the flat country 
seems to exhale the same noxious vapors as marshes, for the 
moisture never fails to meet with a sufficient quantity of de- 
cayed vegetable or animal matter. J 

It was well observed by Sir John Pringle, that wherever 
the greatest cause of moisture and putrefaction in the air 
exists, there also will be the greatest number and worst 
kinds of intermitting and remitting fevers. The same au- 
thor, speaking of the diseases of the West Indies, observes, 
that fevers of the intermitting and remitting forms, with bil- 
ious vomitings, become frequent in June and July, and epi- 
demic in August, September and October, which are there* 
at least in Jamaica, the three most rainy months in the year. 
44 These fevers," says he, " are incidental to natives as well 
as to strangers. But new comers are liable to a different 
species, at least to a different degree of the same disease, 
a more rapid, a more putrid, and a more dangerous fever, 
distinguished by black vomiting, but chiefly by the yel- 
lowness of the skin, which gives it the name of the yellow 
fever."§ 

Dr. Rogers, in his account of the epidemic diseases of 
Cork, says, that during the particular series of years that 

* Percival's Essays, Med. and Experimental, vol. iii. p. 37-8. 

t Diseases of Jamaica, p. 18. 

$ The pernicious effects of excessive moisture or wet weather, in giving 
rise to diseases of a malignant character, was remarked by Hippocrates, 
who says that continual showers give rise to severe diseases, with fevers of 
long continuance, then fluxes of a putrid nature, &c. Per assiduos imbres 
morbi uiagni exparte oriuntur, turn febres longa?, turn albi fiuxiones, pu- 
tridines, comitiales, apoplexia et anginae. Aph. 16, lib. iii. sec. 3. 

$ Diseases of the Army, p. 198. 
F 



42 "Remote Causes of Fever. > 

epidemics were most prevalent, the several seasons were 
remarkable for warmth and moisture.* 

In dry sandy spots nearly surrounded by the sea, where 
there is little or no decaying vegetable or animal matter, 
and where the moisture is immediately absorbed by the 
sand, fevers scarcely ever appear. 

It is observed by Dr. Lind,t that the large rivers in dry 
seasons being confined within narrow bounds, leave a large 
part of their channels uncovered, which having the moisture 
totally exhaled becomes a solid hard crust ; that when the 
rains fall, this long parched crust of earth and clay gradually 
softens, and the ground, which before had not the least 
smell, begins to emit a stench, which in four or live weeks 
becomes exceedingly noisome ; and at this time their sick- 
ness is most violent. The same author further informs us, 
that he was told by a surgeon who had practised some years 
at Senegal, that for several months during the dry season, 
the country was as healthy and as pleasant as any in the 
world, but soon after the rainy season began, a low malig- 
nant fever constantly spread itself among the Europeans. 
It was remarkable, says this author, one year at Senegal, 
that at the beginning of the rainy season, in the night suc- 
ceeding one of those tornadoes, a great number of soldiers 
and two thirds of the English women were taken ill, this 
garrison having before been uncommonly healthy. 

The memorable destruction of Admiral Horner's squad- 
ron, at the Bastimentos, was begun by the scurvy, and com- 
pleted by the malignant fever and flux. In the year 1741, 
no sooner had the rainy season set in at Carthagena, where 
the English troops lay encamped, than the same disease ap- 
peared and was remarkably malignant, became contagious, 
and destroyed the greatest part of the army. 

A prevailing opinion is, that the healthiness or unhealthi- 
ness of any place depends, very essentially, upon the qual- 
ity of the water which the country affords. What has given 
greater currency to this idea is, probably, the circumstance 
of bad water and bad health being frequently found concom- 
itants of each other. Thus in lew, level, wet, and marshy 
situations, the water, from stagnation, and from being im- 
pregnated with the decaying vegetable matter, is generally 
mawkish and disagreeable. In such places, also, intermit- 
ting and bilious fevers are apt to prevail; hence the bad 
quality of the water and the prevalence of the fever have 

* Rogers on the Epidemic Ferers of Cork, p. L 2.». 

t On the Diseases incident to Europeans in Hot Climates, p. 52. 



Remote Causes of Fever. 4*3 

been considered as causes and effects. On the other hand, 
we find that sandy, poor, hilly, dry, and elevated countries, 
for from marshes and stagnating ponds, are generally heal- 
thy ; here, likewise, the water is pleasant, cool, and well 
tasted : this has been considered as another argument in fa- 
vor of the salutary influence of good water as a preservative 
against disease. As the premises, however, are erroneous, 
the inferences which have been drawn in these instances 
must, unquestionably, be equally untrue. And in many 
parts of the country adjacent to the rivers, where springs of 
cool and Shr.pid water issue from the pure sand and gravel 
of the bank, we rind the people in such situations equally 
subject to fevers as those who live in places of a different 
description. It is, indeed, a fact of general notoriety* that, 
in the state of Alabama, the water which issues from the 
banks and bluffs of the rivers is of an excellent quality, whilst 
at the same time it is equally well known that the vicinity of 
rivers and creeks is peculiarly unfavorable to health. 

From these considerations, we are led to conclude that 
the quality of the water has but little influence in the pro- 
duction of endemic fever ; otherwise we should find this 
disease less under the influence of the seasons, and that per- 
sons continuing to drink from the same fountain, if this were 
the prime agent, would be subject to a perpetuity of disease 
through the winter as well as the summer, in situations where 
endemic fevers were apt to prevail. It frequently happens 
at sea, that the ships 1 companies are obliged to make use of 
corrupt and sinking water, yet when their situation is other- 
wise comfortable, no injurious consequences ever happen 
from the circumstance, 

Although the quality of the water has much less influence 
upon the healthiness or unhealthiness of the place than has 
been generally supposed, yet it is not contended that impure, 
stagnant and offensive water is absolutely harmless. A great 
quantity of fluid is consamed in the course of the summer; 
and although the stomach has the power of changing and 
correcting, to a certain degree, the offensive qualities of 
substances received into it, yet this power itself is limited ; 
hence, when the water rs very impure and offensive, and 
drunk in considerable quantity, it may aid the other remote 
causes of fever, or give rise to affections of the bowels in 
the form of dysentery and diarrhoea. But waters, by use, 
may become wholesome and agreeable, which, in strangers 
to their use, at first occasion sickness and diarrhoea. This 
is owing to their saline, mineral, and earthy impregnations, 
and frequently takes place in what are called lime-stone 



44 Remote Causes of Fever. 

countries. But such impregnations are different from the 
offensive impurities of stagnation, and are calculated rather 
to prove serviceable than otherwise, especially to invalids, 
and persons subject to constipation and visceral obstruc- 
tions. 

It is well known that the French are paiticularly partial 
to meats and wild game in a semi-putrid and offensive con- 
dition, the fumes of which would occasion sickness and vo- 
miting in a person unaccustomed to their u?e ; yet the quan- 
tity of vegetables which they use at the same time, and their 
light ascescent wines, counteract any injurious effects that 
might arise from this putrescent quality of their viands : but 
if men were compelled to drink water in a condition equal- 
ly offensive, it would probably be considered as an intolera- 
ble hardship, and the sure occasion of disease, I merely 
mention this circumstance for the purpose of showing that 
more stress is laid upon water in the production of disease, 
than in truth and justice should really fall to its share. 

Fresh rain water, as being more free from every earthy, 
saline, and hurtful impregnation, is, unquestionably, the most 
wholesome water that can be made use of as a common 
drink. "Rainwater," says Hippocrates. u is the lightest, 
the sweetest, the finest and most limpid, J j* 

The subject of moisture will again fall under considera- 
tion, when we come to speak of the predisposing and exci- 
ting causes of fever. 



SECTION 5. 

Of Miasmatic Exhalations. 

The noxious influence of marshy exhalations in the pro- 
duction of malignant fevers, was noticed by Galen ;* but 
the power of marsh miasmata in giving rise to intermitting 
and remitting fevers, was first more particularly observed by 
Lancissi. the Pope's physician, about the middle of the se- 
venteenth century; since which time, the truth and justice 
of his observations have been confirmed by the extensive 
experience of numerous physicians in various quarters of the 
world. As this is a subject of interest and importance to 

* Aqua igitur ex imbufcus collectae, levissimae sunt tenuissimae et lim- 
pidissimae. De Aer Loc. et Aq. Opr. Om. p. 285. 
t De Feb. Differ, lib. i. cap. 2. 



Remote Causes of Fever, 45 

the community at large, as well as to the physician, it may 
be of consequence to illustrate the matter by examples drawn 
from competent and respectable authority. 

From the remarks already made upon the influence of 
heat and moisture, it will be readily understood, that the 
circumstances most favorable to decomposition, the extrica- 
tion of miasmata and the consequent production of fever, 
will take place, where, ceteris paribus, the action of the sun 
is the most powerful, as in equatorial latitudes, the tropical 
and neighboring climates. We have already noticed the 
apparent identity of the cause of fever, and the piinciple of 
vegetation, as occurring in marshy places and in warm cli- 
mates during the summer season. 

In a previous work* I have given my opinion that the in- 
termitting, the remitting, the yellow fever and plague, are 
only gradations and modifications of the same disease ; that 
they all arise from the same causes, differing only in degree 
of force and concentration, and that the proximate cause of 
each is the same. In illustration of which, I noticed the 
circumitance of the intermitting, the remitting, and the yel- 
low fever prevailing at the same time and place, and chan- 
ging and interchanging their forms with each other; that 
which is at one time an intermitting, suddenly assuming the 
character of the bilious or yellow fever; and on the contra- 
ry, the latter divesting itself of its malignancy, and taking 
on the livery and characteristics of intermitting fever. 

These different forms of fever are the prevailing diseases 
in the southern portion of the United States, wherever 
marshes, ponds of stagnating water and corruptible materi- 
als are exposed to the influence of a powerful sun. From 
what I can learn, however, I feel authorized in contradict- 
ing the report of Dr. Jackson, that there is not on record 
an instance of a person born in Petersburgh, Virginia, and 
constantly residing in the same place, who has lived to the 
age of twenty-one. When at Petersburg}), in 1813, I saw 
no particular marks of unhealthiness, the men appeared as 
stout, active, and of as healthy a complexion as they are 
generally found in any part of the southern country. It 
may, however, be laid down as a position, that instances of 
longevity are fewer in proportion in the southern states than 
in those of more northern latitudes. The stimulating and 
relaxing influence of a warm climate, unwholesome exhala- 
tions and frequent attacks of disease, appear to be the cau- 
ses of the early decay of the corporeal powers and vital 

* On the Topography and Diseases of Louisiana. 



46 Remote Causes of Fever. 

principle in man : yet even in New-Orleans (here are found 
many instances of residents who have attained to honorable 
old age by temperance and regularity of life. 

Galen assigns two causes for pestilential fevers : First, 
the great heat of the weather, when the humors happen to 
be in a more putrescent state than usual ; second, and more 
frequently, a putrescent state of the air arising from a mul- 
titude of dead bodies left unburied, as after battle, or from 
the evaporation of corrupted lakes and marshes. 

The noxious effects of marshy exhalations take place in 
Egypt after the Nile retires within its banks, leaving the wet 
ground covered with a variety of putrefying animal and ve- 
getable sub-tances. 

We are informed by Mr. Ives, who travelled from India 
to Europe by land, that at Bagdad, a city containing 500,000 
souls, the Arabs are in the habit of taking revenge for any 
injury done them by the Turks in Bassora, by breaking 
down the banks of the river near this place, in consequence 
of which, a dreadful sickness and mortality are produced. 
This was the case in 1743* when the Arabs, by demolishing 
the banks of the river, laid the environs of Bassora under 
water. The stagnating and putrefying water in the adjacent 
country, and the great quantity of dead and corrupted rish at 
thai time lying upon the shore, polluted the whole atmos- 
phere, and produced a putrid and most mortal fever : of this 
fever, between twelve and fourteen thousand of the inhabi- 
tants died, and at the same time not above two or three of 
the Europeans who were settled there, escaped with life. 

Mr. Macgregor, in his medical sketches of the expedition 
to Egypt- from India, says, one of the principal sources of 
disease in Egypt, is unquestionably the annual overflowing 
of the Nile ; on the subsiding of which, the soil, through a 
great extent of country, is covered with mud and putrid ex- 
uviae, which exhale effluvia noxious to the human body. — • 
If we add to this, *' says he," the extreme filth of the inhab- 
itants, poor diet, close and ill ventilated apartments, much 
crowded narrow streets, and the bad police of the towns, we 
will not be astonished if a fever, at first intermittent, or re- 
mittent, should have symptoms denominated malignant su- 
peradded to the more ordinary symptoms of the disease.* 

During the summer of 1S13, the United States brig Lou- 
isiana, stationed at Fort St. Philips, on the Mississippi, lost 
nearly the whole of her crew by the bilious or yellow fever. 
The country at this place is an entire swamp, and as the ri- 

*Duncan's Annals oi Medicine, vo. 8, p. 264. 



Remote Causes of Fever. 4.1 

vcr is too deep to admit of anchoring in the middle of the 
stream, the vessel was confined to the bank, so that the men 
were immediately exposed to the noxious exhalations of the 
adjoining morass. 

•• If any doubt, says Dr. Hunter,"* can be entertained 
that the exhalations from wet and marshy grounds, are the 
cause of fevers in Jamaica, attending to the following facts 
•cannot fail to remove them. Ships lying at Port Royal with 
their men in perfect health, have in a few days become 
sickly. The men have been seized with fevers, owing to 
the low swampy land along shore, and at the head of the 
harbour, from which last the exhalations are carried every 
morning towards the^ships, when the regular sea breeze sets 
in, as is sensibly perceived by the bad smell which accom- 
panies it." 

1' have remarked in my Observations on the Topograph}/ 
and Diseases of Louisiana, that heat and moisture, by mutual 
co-operation, cause sickness to prevail with the greatest mor- 
tality in the months of June and July. Local circumstan- 
ces, however, may prevent and vary this effect ; as at New- 
Orleans, where sickness is most prevalent and malignant in 
August. This is owing to the number of ponds lying in the 
rear and vicinity of that city, which being filled with water 
through the early part of the season, decomposition is there- 
by prevented from taking place to any considerable degree 
in the morass beneath, till the exsiccation of the water is in 
a great measure effected by the falling of the river and the 
continuance of heat. 

From the same circumstance it happens that a rainy sea- 
son renders the city of New Orleans healthy, by keeping the 
ponds filled with water, whilst it has- a contrary effect upon 
the country generally. In illustration of this circumstance, in 
the work above referred to, I called the attention of the 
classic reader to the recollection of the instance related in 
the history of Empedocles, the Sicilian philosopher and po- 
et, who put a stop to pestilential diseases among the Sala- 
centi, by turning two streams of good water into the morass 
from which they originated. Dr. Dazilles, in his treatise 
upon the diseases of the negroes in the West Indies, informs 
us. that the rainy season is the most healthy at Cayenne, 
owing to the neighboring morasses being deeply overflowed. 
It >s well known that the overflowing of the Nile puts a stop 
to the plague in Egypt, by covering the low grounds, and 
preventing the progress of putrefaction in the alluvial mat- 

* Observations oh the Diseases of tjae Army in Jamaica, p. 2& 



48 Remote Causes of Fever, 

ters which lie upon the surface of the earth. The letting 
out of the water from the fosses of fortified towns, has pro- 
duced malignant remittents, and the letting it in again has 
put a stop to their progress. Sir John Pringle speaking of the 
diseases ofFianders, where, from the low damp situation, in- 
termittent fever is the prevailing complaint, observes that 
when the heat comes on soon and continues throughout au- 
tumn, not moderated by winds and rains, the season proves 
sickly, the distempers come on early, and are dangerous ; 
but when the summer is late, and tempered by frequent 
showers and winds, or if the autumnal cold begins early, the 
diseases are few, their symptoms mild, and their cure easy. 
For in marshy grounds, intense and continued heats, even 
without rain, occasion much moisture by the exhalation 
which they raise and support in the atmosphere; whereas 
frequent shower? during the hot season cool the air, check 
the rise of vapours, dilute and refresh the corrupted water, 
and precipitate noxious effluvia. We are informed by the 
same author that the inhabitants of Breda, during the season 
of bilious fevers, secure themselves from the noxious ex- 
halations of a piece of marshy ground in its vicinity, by over- 
flowing it with water.* 

It is stated by Purchas, that 500 persons less died 
of the plague the day after the Nile overflowed the ground 
which had emitted the putrid exhalations that produced it, 
than had died the day before. 

The manner in which the inundation of marshy grounds 
prevents the extrication of noxious exhalations, is not so 
much by the exclusion of air, for water is always saturated 
with atmospheric air, by which fishes are enabled to live in 
this element, as by keeping the temperature of the surface 
below the degree necessary for the speedy decomposition. 
As the particles of water heated by the suivs rays are specifi- 
cally lighter than those beneath, it, of course, is physically 
impossible that they should descend, so as to impart their 
warmth to the subjacent stratum, as long as they retain this 
disproportionate superiority of temperature ; so that when 
the water is deep the bottom must always remain unaffected 
by the heat of summer, and will consequently remain cool 
while the surface is warm, and in this way decomposition is 
prevented from taking place in the subjacent mass of vege- 
table and animal matter. Where, however, a thin sheet of 
water only is spread over the surface of the soil, the whole 
body of the fluid becomes heated by the sun, and decom- 

* Diseases of the Army. 



Remote Causes of Fever. 49 

position takes place with as great and even greater facility 
than in those places where no stagnation of the water oc- 
curs. Water, however, is not so easily heated by the sun as 
the earth, and for two very sufficient reasons ; ist, the re- 
flection of the sun's rays from the surface, by which they are 
prevented, in a great measure, from penetrating this fluid : 
2d, the evaporation which takes place from the surface of 
the water, cooling the subjacent portion. The refrigerating 
power of evaporation will be explained under the head of 
Prevention. 

Offensive exhalations, from whatever source, are probably 
analogous in their chemical and morbific properties to marsh 
miasmata, and are calculated by their offensive odour to in- 
form us of their deleterious quality. There is probably no 
situation of the like dimensions so likely to generate fevers 
of a typhoid character as a ship, owing to the following 
causes : 1st, a vessel always contains a greater or less quan- 
tity of bilge water, which soon becomes putrid, as well 
from its own nature as from the mixture of various substan- 
ces in the hold, and consequently emits unwholesome va- 
pours: 2d, the close and confined construction of a vessel, 
and its many crannies and corners excluding a free circula- 
tion ofajr, and favouring the accumulation of filth : 3d, the 
crowded slate of a vessel, and the little attention paid by 
saiiors to personal cleanliness: 4th, the frequent want of 
fresh and wholesome provision : 5th, the qualities of the 
cargo, which frequently become offensive, and generate dis- 
ease. " There was no sickness," says Dr. Blane, in the 
Ville de Paris, when in possession of the enemy, and the 
sickness winch prevailed after her being captured seemed 
to proceed from what maybe called simple putrefaction. — ■■ 
There was an instance of the same kind in one of our ships 
of the line, in which a bad fever broke out in the month of 
July, which seemed to be owing to the foul air of the neg- 
lected hold, for there was a putrid stench proceeding from 
the pumps, which penetrated the whole ship."* From the 
degree of putrefaction which often takes place in the hold of 
a vessel, we need not be surprised that fever of a malignant 
character, and -con the yellow fever itself, should sometimes 
he generated on ship- board. It is still fresh in the recollec- 
tion of many, how great a mortality occurred on board the 
Macedonian frigate, after a cruise of two months among 
the West India islands, in the summer of 1822. She arrived 
in Hampton Roads about the 5th of August, having lost 77 

* Blane on the Diseases of Seamen, p 136. 
G 



50 Remote Causes of Fever, 

of her crew, officers and sailors, with upwards of 50 sick on 
board at the time of her arrival. Such also was the fate 
which befell the crows of the frigate General Greene, com- 
manded by Capt. Perry, the elder, which returned home in 
the year 1793 from the West India station; and the bomb 
ketch Etna from a similar cruise in 1807. 

The yellow or bilious fever was generated on board the 
British ship Hibbert in 1804, on her passage from Ports- 
mouth to New York, in consequence of her extremely foul 
and filthy condition.* Several of her people had died on 
her passage to Ncw-lork, whence she sailed without cleans- 
ing [or Honduras, " as foul," says the editor of the Medical 
Repository, "as Styx or Cocytus." This vessel had been 
employed as a transport for soldiers from Portsmouth to 
Halifax, thence to Nassau in the Bahamas, and thence home 
to Portsmouth. There was so much offensive filth in this 
ship, that a physician, who went on board, declared he could 
with difficulty refrain from vomiting, on account of the filth 
of the great cabin. The disease was not communicated out 
of the vessel. The sickness and mortality on board this ves- 
sel, caused considerable alarm at Honduras ; but as the dis- 
ease was not communicated, all apprehensions subsided. — 
The inhabitants of Honduras, who extol the salubrity of 
their own settlement, according to the ruies of contagionists, 
with much plausibility, traced the (ewer which prevailed on 
board the Hibbert, to New-York, the place from which she 
last sailed. Thus overlooking the efficient causes which 
were obvious and cognizable to the senses, and entirely ex- 
onerating the filthy condition of the vessel, in their zeal to 
trace the contagion to a foreign port. 

Baron Laray, speaking of the diseases of Egypt, says, 
" The south winds are*loaded with the putrid effluvia of ani- 
mal and vegetable substances, evolved by the heat from the 
lakes that are formed by the subsidence of the Nile, or in 
the countries that are affected by the inundation ; hence the 
principal causes of pestilential diseases. After the inunda- 
tion of 1801, the plague made the greatest ravages among 
the inhabitants of Cairo and Upper Egypt. At this season, 
also in 1 800, the yellow fever prevailed, and attacked our 
wounded, particularly at the siege of Cairo, while the plague 
scarcely appeared. I am led to believe that the atmosphere 
of Egypt, at this season of 1800, was analogous to that of St. 
Domingo. *'t The sickly season, which the Baron calls the 

* Me<L Herns. Vol. VIII. p. 71. 

? Laray's Memoirs on the Campaigns of the French Army in Egypt. 



Remote Causes of Fever. 5.1. 

fourth, begins about the first of March, and generally con-? 
tinues till the end of May. 

Doctor Alibert's fourteenth proposition on malignant in-* 
iermittentSs is, that "all matters susceptible of decomposi- 
tion more or less rapid, communicate a deleterious quality 
to stagnant waters, and render them capable of producing 
malignant infermittents." 

It should be understood that what are called marsh mi- 
asmata, are not the result of pure and unmixed vegetable 
decomposition. According to the account of Lancissi, 
Charles Leigh, aided by a microscope, submitted the water 
of marshes to a very strict examination, and found it to be 
filled with a mixture of leaves, herbs, flowers, roots, seeds, 
&c. The myriads of wild bees, (says Dr. Mitchell,*) lo- 
custs, ants, cockroaches, sand flies, musquetoes, which trav- 
ellers have noticed, and hundreds of other insect species, of 
which they know neither history nor name, must by their 
annual deaths, make an incalculable mass of animal putre- 
faction. The frogs, nut.es, lizards, alligators, and other am- 
phibious creatures, which yearly expire, add greatly to the 
heap. The different venomous kinds of animals, inhabi- 
tants of the water and mud, contribute mightily to the sum ; 
and to all this must be added the vast amount of fishes, 
which die natural deaths, and are left to perish or rot upon 
the shore. 

In the fever of Walcheren, which committed such rava- 
ges among the British troops, the causes are ascribed by Dr. 
Davis, 1 to the low and damp situation of Walcheren ; the 
offensive stench which proceeded from the half smothered 
flames on entering the town ; from the inundation laying 
half Walcheren under water, and which was even widely 
spread through the British lines, and lastly from many of 
the French being buried in heaps, for the purpose of con- 
cealment, and at the same time with a very superficial co* 
vering of sand. The disease prevailed with particular ma- 
lignancy in the months of August and September, under the 
forms of quotidian, tertian, quartan, and remitting type, but 
more especially the double tertian, becoming more malig- 
nant by continuance, and degenerating into the continued 
and typhus character. 

Hungary abounds with rivers, which, by often overflow- 
ing, leave that low flat country overspread with lakes and 

* Tracts on Septon. p. 21. 

t Scientific a>nd Popular View of the Fever of Walcheren, Introduction, 
p. 11-12. 



52 Remote Causes of Fever, 

ponds of stagnating water, and with large, unwholesome, and 
putrefying marshes. The heat of the sun in summer, is 
more intense in Hungary (according 10 Kramer) "ban in 
any other part of Europe; and in proportion to the Heat, 
the more pestiferous are the marshy exhalations. From 
what Kramer and others have advanced concerning the poi- 
sonous constitution of the air of Hungary, we may account 
for the vast and almost uniform fatality of the variolus and 
other pestilential diseases to which that country is unhappi- 
ly subject.* In Temeschwar, the capita], a healthy person 
is scarcely to be seen. Baron Born, when here, fancied 
himself in the realms of death, inhabited by carcasses in tine 
tombs, instead oi men; and at a dinner, to which lie was 
invited, all the guests had a fit of the fever, some shivering, 
and others gnashing their teeth. t 

In further illustration of this subject, I will here subjoin 
some useful observations by Dr. Golden, extracted from his 
work on the yellow fever of New York in 1741 and 1742, 
from the first volume of the American Medical and Philo- 
sophical Register. 

Dr. Rosinus Lentilius, the duke of Wirtemburgh's chief 
physician, observes, that there having been formerly a large 
swamp in the neighborhood of Stutgard, the capital of the 
country, that city was yearty subject to malignant fevers; 
hut that upon the swamp being drained and converted into 
meadow ground, the city afterwards became healthy. In 
1608, the river Morano having by a flood overflowed its 
banks, rilled the adjacent lower part of the city of Rome 
with stagnating waters, which remaining there, corrup ed, 
and sent forth stinking vapors, whereby the adjoininc bouses 
were infected, and became unpeopled by the death 
of the inhabitants. Pope Clement VIII, ordered large drains 
to be cut, by which that part of the town was kept dry, and 
it continued afterwards always as healthy as the other parts 
of the city. 

In 1695, that part of the city of Rome called the Leonine, 
became noxious and offensive to the inhabitants of that quar- 
ter, who were seized with epidemical fevers : as were like- 
wise those of the adjoining parts to the northward of it: 
whilst those immediately to the southward, and the more 
distant quarters, remained healthy : these diseases were 
found to be owing to the neglect of scouring the ditch of 
the castle into which that quarter of the town was drained : 

* Lind on the Diseases of Seamen, p. 57. 

* See Edinb. Encyclop, Avt. Hungary. 



Remote Causes of Fever, 53 

by cleaning out the ditch and opening the drains, that part 
of the town recovered its usual healthiness. The same au- 
thor likewise takes notice that the owners of a particular 
part of the city where there were ruins of some old large 
buildings, having dug deep into them for materials for 
building, and suffering the water to stagnate in the pits, it 
began to stink, and the inhabitants of the neighborhood were 
seized with malignant fevers, which continued till these pits 
were tilled up, after which the disease entirely ceased. The 
Tiber having overflowed its banks the 23d of September, 
Laneissi, chief physician to the reigning Pope, Clement XI, 
signified to the Pope the danger that the health of the in- 
habitants would be in from the stagnating waters, if they 
were not removed before the approach of summer. He 
set fc*lh that the turbid water being carried into the lower 
parts of the town, filled the cellars of the houses and the 
wells, the waters of which chiefly served the common peo- 
ple for drink : that these waters, as they are strained off the 
earth, leave behind them all the filth with which they were 
impregnated from the dead bodies of insects, the carcasses 
of dead beasts, &c. ; that this slime during winter remains 
fixed, and emits no vapors, but after the summer heat be- 
gins, it ferments and sends forth noxious vapors, exceedingly 
prejudicial to all the vital parts of the human body, and pro- 
ductive of fevers of the worst sort. He adds, that noxious 
vapors are not only thus produced at Rome, but in every 
other warm climate, except where they have frequent gusts 
of northerly winds during the summer, which dissipate va- 
pors, that otherwise would remain in the circumambient air 
where they are generated. He puts the Pope in mind, that 
not long before a great destruction had happened among the 
inhabitants by camp or pestilential fevers, and that by the 
neglect of the governors of the city on an occasion like this. 
The prudent Pope, pursuant to his physician's advice, issued 
an edict for draining the waters, and clearing the city from 
al! the slime and filth, and for keeping it clean and dry for 
the future : and care being taken to have this edict effectu- 
ally put in execution, the city had remained to the time Lan- 
cisi wrote his book, the space of fifteen years, entirely 
free from all fevers of that kind. Pesaro is situated at the 
mouth of a river, near the Adriatic sea, in a plain, near great 
quantities of marshy and oozy grounds, and was famous in 
ancient times for the unhealthiness of the place. It con- 
tinued so for many years, so that scarcely any of the inhabi- 
tants ever reached fifty years of age, until it had the good 
fortune to fall under the government of a wise prince, who,. 



54 Remote Causes of Fever, 

in order to relieve the inhabitants from the mischievous ef- 
fects of the situation of this place, opened the channel of the 
river, cut its course more direct, made large canals for drain- 
ing off the water of the low places; and where they could 
not be drained, filled them up. This was done in the years 
1515, 1517, and 1518 ; and from that time the city became 
healthy, populous and opulent; until the citizens, forgetting 
from what cause they enjoyed such blessings, suffered the 
channel of the river to fill up, and neglected the drains : this 
occasioned, in the years 1708 and 1709, grievous malignant 
fevers. An engineer was sent, by Lancissi's advice, to Pi» 
saro, to contrive proper methods for draining the country, 
which being effected, the city was restored to its former state 
of health. Other instances of a similar nature are mention- 
ed by the same author. The Roman historians observe, that 
as often as the drains of the city were neglected and stop- 
ped, so that the water and filth stagnated, the city became 
unhealthy, and the inhabitants were wasted by malignant 
and pestilential fevers. When this happened, the Romans 
spared no cost to cleanse and keep the city clean. C. Aquii- 
ius writes, that the common sewers being stopped by neg- 
lect, the Censors bestowed a thousand talents in opening and 
cleansing them. And it was the business of the iEdiles and 
Curators to superintend and enforce the necessary work. 
The effect of this care is manifest, when so great a city, 
crowded with such vast numbers of people? during ail the 
time of its grandeur, remained exceedingly healthy, though* 
by the nature of the soil, it was most likely to be otherwise. 
But after all these works for keeping the city clean were 
destroyed by the incursions of the Goths and Vandals, Rome 
became exceedingly unhealthy.* And Pope Innocent III. 
writes in the 12th and 13th centuries, that few in Rome 
reached 40 years of age, and scarcely any 60. From 1705, 
malignant pestilential fevers became yearly epidemical in 
Urbevetano, a town formerly very healthy ; this, Lancissr 
said, was occasioned by the inhabitants digging many pits in 
their low lands near the town, for rotting flax and hemp, at 
the same time neglecting these drains, and suffering their 
streets to become offensive to the smell by the filth that re- 
mained upon them. By Lancissi's advice, the Pope order- 
ed these pits near the town to be filled up, and others made, 

* Romana vorax horninum domat ardua colla virorum ; 
Roma ferax febrium necis est uberirna frugum ; 
Romanae febres stabili sunt jure fideles, 
Quem seaiul iiwad tint, vis a vivente recedunt, 

Dabjiasi, 



Remote Causes of Fevef. 35 

at a greater distance from the town. That the drains, cis- 
terns, and cellars of the town, and the pits for rotting the flax 
and the hemp, should be yearly cleaned in the months of 
January and February, that the slaughter-houses should be 
removed out of the city, and set in such places where the 
filth exhaled, might be constantly washed away by every 
rain. These orders being effectually put in execution, the 
fevers did not return the following summer; and the town 
remained fvee from them to the time that Lancissi wrote in 
1716. The citizens wrote an inscription on one of Iheir 
gates, in commemoration of their deliverance from these 
pestilential fevers, and of the means by which it was procu- 
red. On the 1st of May, 1?07, the hilly grounds to the 
southward of the town of Bagnarea, after continued great 
rains, began to fall into the river which was near that town, 
in such a manner that whole vineyards were moved from 
their places, and some houses entirely, without falling: in. 
one of them a woman was delivered of a child, while the 
house was on its march. The channel of the river was 
choked and filled up. Numerous cracks, gaps and holes, 
were left in many parts of the ground, in which the waters 
stagnated and became extremely offensive to the smell. In 
the summer heats, the color of the inhabitants became of a 
dead swarthy yellow, and grievous pestilential fevers seized 
them. These were confined to the southern and lower parts 
of the town, while the other parts which stood high and at a 
distance from the stagnating waters, out of reach of the va- 
por which arose from thence, remained healthy, as usual. 
The channel of the river, by order of the magistrates, being 
cleared, drains made for carrying off the water, the places 
where it stagnated cleared, and the cavities, which could not 
be drained filled up, the inhabitants were the next summer 
freed from them till the time that Lancissi wrote, and he 
doubts not that they will continue so as long as they shall 
continue to keep the town and adjacent parts clean and free 
from stagnating water. In the public thanksgiving, ordered 
for this deliverance, the bishop declared the obligations they 
were under to Lancissi, by whose advice they had been de- 
livered from such pernicious diseases, Lancissi was so 
much confirmed by long experience, that these kinds of fe- 
vers are occasioned by stagnating waters, that whenever he 
heard of such fevers breaking out in any place, he did not 
hesitate to affirm that they were occasioned by filthy offen- 
sive water, or slime stagnating in those places, and frequent- 
ly before the inhabitants themselves had taken notice of the 
cauiei This his conjecture was always confirmed upon a 



36 Remote Causes of Fever. 

proper inquiry. Ramazzini likewise observes, that in 16S0. 
the inhabitants of the low moist parts of Modena were seiz- 
ed with epidemical fevers, while those of the high part of 
the city remained perfectly healthy. "I remember," says 
Dr. Colden, " that several years since when 1 was at Bris- 
tol, in Pennsylvania, opposite to Burlington, which is situa- 
ted to the northward of a large piece of swampy ground, 
they told me that they had been, from the first settling of 
Bristol, subject to intermitting fevers of a malignant kind. 
and, indeed, the aspect of the inhabitants showed the ill ef- 
fects of the air which they breathed. They assured me. at 
the same time, that not above two or three children, born 
in that village, since its first settling, had attained the age 
of maturity ; but since that time, these swamps having been 
drained, and converted into profitable meadow grounds, I 
am informed that Bristol is in a great measure freed from 
those annual epidemical fevers. A fresh water pond and 
meadow of stagnating water, not a mile to the northward of 
the city of New York, has been lately drained for the benefit 
of the soil, without any thought of any advantage to the 
health of the neighboring inhabitants, though its effects in 
that respect are very manifest. Every summer the inhabi- 
tants of the houses on the north side of it, before it was 
drained, were subject to malignant intermittent^, and seve- 
ral, in the few houses there, yearly died. Since the drain- 
ing of that place, these houses are become as healthy as any 
in the neighborhood. Caspar Cantarini, in his account of 
the republic of Venice, mentions a new college, or council 
of magistrates, appointed not long before his time, to take 
care of the health of thatxity, and who^e business, among 
other things, was to cause all filth and other nuisance to be 
removed, and the city kept clean. He observes, that before 
this institution, Venice had been frequently subject to pes- 
tilential distempers, insomuch, that many of the inhabitants 
for that reason had deserted their houses, and removed their 
families to the continent ; but, that after these magistrates 
were appointed, who continued vigilant in their duty, the 
city had always remained hee from any malignant pestilen- 
tial distempers." 

Antoninus Galatheus attributes the unhealthiness of the 
once famous Brundiisium, to the neglect and carelessness of 
its inhabitants. £i Moreover," says he, " cities situated in 
a healthy climate have been destroyed. Cities, indeed, like 
men, have their vicissitudes, but the neglect of its inhabi- 
tants has been the ruin of Brundusium ; for had outlets- 



Remote Causes of Fever, 8 s ? 

been made for its waters, it would never have acquired such 
an unhealthy distinction." 

Dr. Robert Hamilton ascribes the fever which prevail- 
ed at Lynn in 1779, and the five following years, to an 
inundation from the sea, leaving on its recess a mass of 
animal and vegetable matter to putrify upon the shore.— 
This wvev he considers to be of the same nature as the yel- 
low fever of the West Indies, as described by Dr. Hillary; 
the tertian of Minorca, by Cleghorn ; and the remitting fe- 
ver of Bengal, by Clark. He observes, that many conva- 
lescents from this disease became scorbutic and dropsical.'* 

It is remarked by the celebrated Zimmerman, that exha- 
lations from marshes do not seem to be so noxious in cold 
as in hot countries, yet malignant fevers occur, as in Zea- 
land. In Germany, these exhalations produce tertians ; in. 
Hungary, petechial fevers; in Italy, (he hemitritaae ;t and 
in Egypt and Ethiopia, pestilential fevers. J 

It would be a curious and interesting subject of investiga- 
tion, to trace the gradually increasing malignity of endemic 
fever from the northern boundary of the temperate to the 
torrid zone. We should find, that, other circumstances be- 
ing alike, there would be a progressive increase in the se- 
verity of the symptoms as we approximate towards the sul- 
try climate of the equatorial latitudes; and that local cau- 
ses, which, as far north as New-York, would merely give 
rise to regular tertians,, in Georgia and Alabama would pro- 
duce the yellow fever, or the malignant bilious remittent. 
This influence of change of climate in mitigating or aggra- 
vating the character of endemic fever, corresponds with the 
progress of the season in changing the type of local epi- 
demics. 

In Zarbat, in Scotland, a putrid fever sometimes occurs, 
and after death the body turns yellow : this may be ascri- 
bed to certain natural locks or ponds which sometimes dry 
up in the summer.§ 

One of the most remarkable diseases incidental to an ar- 
my, recorded by Diodorus the historian, broke out among 
the Carthagenians at the siege of Syracuse, about 410 years 

* Observations on the Marsh Remit. Fever, p. 87. 

t " The febris hemitritea, or semi-tertian fever," says Senac, " we may- 
consider as a continued double tertian. Such, however, is the peculiarity 
of its type, that one of its paroxysms is ushered in by a cold fit, whilst the 
next is not, and so on, alternately. Senac on Intermitting and Remitting 
Fevers, p. 105. 

X Zimmerman on Experience in Physic, p. 131. 

$ Sinclair's Scotland. 

H 



#5 Remote Causes of Fever* 

before the Christian era. This was at the time of the fa- 
mous expedition of the Athenian generals, Eurimedon and 
Demosthenes. The disease originated from an offensive 
marsh in the vicinity of the city, and increased to such a 
degree of malignancy as to destroy nearly the whole army.* 
In the 14th book, chapter 7th, the same author gives a de- 
tailed account of a fata! disease which invaded the Cartha- 
genians the year before Christ 394, when encamped upon 
the same ground that had been formerly occupied by the 
Athenians. He calls it a plague; and tells us it was first 
ascribed to the vengeance of the gods, for the rifling and 
plundering the temples of Ceres and Proserpine. Physical 
causes, however, of a local nature, were considered by him 
as the principal occasion of the disease. The ground was 
wet and marshy; great multitudes were confined within a 
narrow compass, exposed to the scorching heat of the sun 
by day, and by night to the cold damp air, and noxious steams 
and exhalations, arising from the marshes and from the bo- 
dies of those who lay unburied. The symptoms were ca- 
tarrhs and swellings of the throat, which were caused by the 
stench of the dead bodies, and the miasms from the swamps 
and low grounds. These symptoms were followed by fe- 
vers, pains in the back, heaviness of the loins, dysenteries, 
blotches and boils over the whole body. Some, in a state of 
raging madness, ran about the camp and beat all that came 
in their way. 

It is said of Syracuse, that " the least stagnant water is 
sufficient, in the heat of summer? to poison the atmosphere : 
its effects on the countenances of the poor people who live 
in its vicinity, are very evident ; and a stranger who travels 
through the island in this season, ought to avoid ever pass- 
ing a night near them." (Ec nige Berichten, &c.) '« As 
soon as the sun enters the lion, this country becomes the 
house of death : fevers of the most malignant kind, seize 
upon the imprudent or unfortunate wretch that spends a 
night near them, (ponds and marshes ;) and few escape with 
life when attacked by so violent a disorder.''! 

Fracastorius attributes the pestilential fever attended with 
petechias, which appeared in Italy about the year 1530, to 
an extraordinary inundation of the Po, which upon receding 
left the marshes to corrupt and infect the air through the 
summer. 



* Diodorus, lib. xiv. cap. 2. 

t Swenburn'a Travels, Vol. II, § 49, Dublin edit. 



Remote Causes of Fever: $9 

It is recorded by Forestus, that from the putrefaction of 
the water, the city of Delft, in which he practised, was 
scarcely, two years together, free from the plague or som$ 
pestilential distemper. 

In the year 1 694, a fever broke out at Rochfort, in France, 
which, on account of the uncommon symptoms and great 
mortality, was at first believed to be the plague. But M. 
Chirac, who was sent by the court to inquire into its nature^ 
found the cause to arise from some marshes that had been 
made by an inundation of the sea. He observed, that the 
offensive efEivia, which smelt like gun-powder, were car- 
ried to the town by the wind, that had long blown from the 
quarter where these marshes were situated. Such was its 
mortality, that two thirds of those who were seized, fell vic- 
tims to the disorder.* 

It is remarked by Assaiini, in his account of the diseases 
of Egypt, that the heavy rains which fall during the winter 
at Damietta, Rosetta, and Alexandria, contribute greatly to 
produce disease, which the south winds, the fogs, and the 
exhalations of the marshes, render more dangerous ; and 
that the diseases are most frequent when the inundations of 
the Nile are high and of long duration." "At this day," 
says he, " the lakes, the marshes, and the filthiness which 
one finds in the cities of Lower Egypt, are the principal cau- 
ses of the frequent diseases to which they are subject, and 
which can never be eradicated until we have found means 
to purify the atmosphere of their environs. This important 
advantage maybe obtained by draining off the waters of the 
lakes, and filling them up ; by keeping the cities clean, and 
giving a free exit to the rain water, which stagnating in dif- 
ferent parts of the cities becomes corrupted, and conjoined 
with filth, infects the atmosphere." 

Baron Laray informs us, that from the 21st of August till 
the autumnal equinox, the inundation of the Nile increases, 
and all Egypt is like a sea, in which the towns and villages 
appear like so many islands, and the inhabitants communi- 
cate with each other by means of boats. Towards the end 
of September, the waters retire, when they cultivate the 
earth. The sickly season begins about the first of March, 
and generally continues to the end of May.t 

* This statement is quoted by Sir John Pringle, from Traits du Fievres 
Maligns. Oeuvres Posthum. de M Chirac, Eleg. de M. Chirac, par M. de 
Fontville In those who were opened, says Sir John Pringle, the brain was 
found either inflamed or loaded with blood, the fibres of the body were un- 
commonly tender, and the bowels were either mortified or in a state ef 
suppuration. 

t Laray's Memoirs, Amer, Edit. Vol, h 



60 Remote Causes of Fever. 

We are informed by Dr. Lind,* that in the month of Au- 
gust, when the thermometer often rose to 82° in the middle 
of the day, the marines, who were exercised three times a 
week, early in the morning on the South Sea beach, suffer- 
ed much from the effects of an adjoining morass. Half a 
dozen of them at a time, were frequently taken ill in their 
ranks, while under arms ; some were seized with such a gid- 
diness in the head, that they could scarcely stand ; others 
fell down speechless, and upon recovering their senses com- 
plained of a violent head ache. When such patients were 
received into the hospital, some few had a regular ague, 
but far the greater number labored under a remitting kver, 
in which, indeed, there was no perceptible remission for 
some days. A constant pain and giddiness in the head were 
the most distressing and inseparable symptoms of the disease. 
Some were delirious, and a few vomited a quantity of bile; 
in all, the countenance was yellow. 

It is related by Lancissi, that thirteen gentlemen and la- 
dies of the first rank in Rome, having made an excursion 
upon a party of pleasure, towards the mouth of the Tyber, 
the wind suddenly shifted, and blew from the south over the 
putrid marshes, where the whole party, with the exception 
of a single individual, were immediately seized with a ter- 
tian fever. 

Cabbages, as abounding with azote, approach in their 
chemical properties to the nature of animal matter, and in 
undergoing decomposition, become extremely offensive and 
unwholesome. Instances of fever originating from this 
source, have frequently occurred. One is related by Dr. 
Rogers,! and another, much to the point, is given by Dr. 
Bailey, in his Treatise on the Epidemics of New-Yo:k in 
1795, page 84, et. seq* " Some time since," says the Doc- 
tor, " I was called to visit a young man about eighteen years 
old, in a family in the skirts of the town. (Hartford.) He 
was violently attacked with most of the characteristic symp- 
toms of yellow fever. The next day, a second was taken 
in the same manner ; and on the morning of the third, three 
more were taken sick. This led me to suspect some par- 
ticular cause. I searched for it in vain that time. The 
next morning, in passing through the kitchen, I smelt some- 
thing that was very offensive, which none of the family had 
noticed. On opening the cellar door, I found that it pro- 
ceeded from the cellar. Two persons went down to exam- 

* Essay on the Diseases incidental to Europeans in Hot Climates, p. 23. 
i Essay on the Epidemic Diseases of Cork. 



Remote Causes of Fever, 61 

ine, and found in one corner of a small tight room, a quan- 
tity of June cabbages, on which the sun had shone about 
three hours in the day. They had rotted, and sunk down 
in a heap of putrefaction. They run a stick under them 
and lifted them up, and there immediately issued such an 
intolerable stench, as obliged them instantly to leave the 
cellar. A vomiting was brought on, which lasted more than 
an hour.. Notwithstanding that the doors and windows of 
the cellar were thrown open, it was two days before they 
could clean it out. No other person in the family was ta- 
ken afterwards, and those who were already seized soon re* 
covered." 

Aheap of cabbages, in a state of putrefaction, gave rise 
to a malignant fever at Oxford several years ago, which 
proved fatal to several students of that university, and to 
many of the inhabitants of the place. 

Dr. Rogers, in his account of epidemic diseases, ascribes 
the unhealthiness of the city of Cork in his time, to the fol- 
lowing circumstances. The city of Cork is built on islands, 
surrounded by branches of the river Lea, in their own na- 
ture marshy, and which were subject to the overflow of the 
spring tides, till the ground was raised by art: it is situated 
in a deep valley, where the rest of the marshes, both of the 
east and of the west, are constantly covered by the over- 
flowing of the spring tides ; and in the interim, putrid vapors 
are exhaled from them ; continued ridges of hills bound this 
vale on the north and south, on which the suburbs are built. 
Besides this situation of the town itself, he mentions four 
other concurring causes. First, the great quantities of filth, 
ordure, and animal offals in the streets, and particularly the 
close, confined alleys and lanes. Secondly, the great num- 
ber of slaughter-houses, both in the north and south suburbs, 
especially on the north ridge of hills, where are vast pits for 
containing the putrefying blood and ordure, the Steam and 
vapors of which taint and corrupt the wholesome breezes. 
Thirdly, the unwholesome and foul waters, that great num- 
bers of the inhabitants are necessitated to make use of du- 
ring the dry months of summer. Fourthly, the vast quantity 
of animal offals used by the meaner sort, during the slaugh- 
tering seasons; which, according to our author, occasions 
still more mischief, by the quick and sudden transition from 
a diet of another kind and different nature.* 

Pulo Bay, in the East Indies, is remarkable for the pes- 
tiferous quality of the air, occasioned by the lowness and 
swampiness of the soil, full of ponds of stagnating water, 

* Rogers on Epidemics, p. 36-7. 



62 Remote Causes of Fever, 

which exhale an offensive effluvium. Capt. Delano says, 
that he lost there twenty men of his crew, in half the num- 
ber of days.* 

The indigenous fevers of Batavia, Calcutta, Goree and 
Surrinam, are universally acknowledged to originate from 
the exhalations of putrefying animal and vegetable matter. 
In all spots of the East Indies situated near large swamps,! 
on the muddy banks of rivers, or the foul shores of the sea, 
the vapors exhaling from the putrid stagnating water, either 
fresh or salt, from corrupted vegetables and other impuri- 
ties, produce mortal diseases, especially during the rainy 
season. There is a place near Indrapour, in Sumatra, where 
no European can venture to remain, or sleep one night on 
shore during the rainy season, without running the hazard 
of his life, or at least a dangerous fit of sickness. And at 
Padang, a Dutch settlement at Sumatra, such is the pesti- 
lential quality of the air, that it is commonly called the 
plague coast. There a thick pestilential vapor or fog ari- 
ses after the rains, from the marshes, which destroys all 
white inhabitants. 

I shall here add a few remarks on the climate of Batavia* 
as illustrative of the subject on which we are treating, and 
serving to show the powerful influence of heat, moisture and 
putrefaction, in the production of diseases. The following 
paragraph is extracted from the Edinburgh Encyclopedia. 

After describing the abundance of its productions, and the 
beauty of the country, the author draws the following mel- 
ancholy contrast. " In the midst of plenty, beauty and 
gaiety, every countenance indicates debility and languor. 
There is pestilence in the air, and poison in the water. The 
atmosphere is constantly infected with deleterious vapors, 
which rise from the surrounding swamps and morasses ; and 
the trees zvith which the quays and streets are crowded, impede 
the free circulation of the air. which otherwise would, in some 
degree, be dissipated, (qr. renovated.)! Fevers, which are 
here the general denomination for all kinds of illness, are 
continually raging in the colony. Of strangers, who came 
to settle at Batavia, three out of five are reckoned to die the 

* Delano's Voyage?, p. 153. 

i Lind on the Diseases of Hot Climates, p. 85. 

J These lines marked in italics are exceptionable, since, as has already 
been shown, the growth of trees and plants is one of the greatest natural 
preservatives of health ; and so far from causing an obstruction to the wind, 
when planted in straight lines parallel with the streets, as they should be, 
they aid its circulation, by producing a greater degree oi coolness in their 
vicinity and shade. 



Remote Causes of Fever. 63 

first year; and it appears from calculation, that the compa- 
ny Jose annually one fifth cf their servants. Such is the 
general apprehension of the unhealthiness of this colony, 
that even the temptation of quickly amassing a splendid for- 
tune is insufficient to induce those who can reside at home 
with any comfort, to seek a settlement in Batavia. Many 
offices and professions are thus necessarily entrusted to per- 
sons little qualified for fulfilling their duties ; and it is wor- 
thy of remark, that one of the clergymen, and the principal 
physician, had originally been barbers." 

Dr. Ffirth, in his account of Batavia, has, likewise, some 
interesting observations.* He represents the exhalations 
arising from the mud and stagnating water as extremely dis- 
agreeable, and of such pungency and strength as to occasion 
opthalmia, vertigo, nausea and vomiting, upon exposure to 
them. " In going up the canal," says the Doctor, " from a 
ship lying in the harbor, you are certain to meet large quan- 
tities of putrid animal matters floating down. What with 
the sight of dead Malays, in every stage of putrefaction, and 
torn in pieces by the alligators, dead horses, cows, &c. 
producing an intolerable stench, and the inundations from 
the banks of the canal, and the meadows already mentioned, 
combined with the intense heat of the sun, and its reflection 
from the water, you are certain to have a considerable de- 
gree of nausea, with head-ache and great languor produced. 
Strangers, on the slightest irregularities, are sure to suffer, 
as it only requires an exciting cause to produce the disease 
at any time." 

Dr. Ramsay, in a letter to Dr. Mitchill, enumerates the 
following as the causes of the pestilential sickness in Nor- 
folk, Virginia, in 1795.J The warmth of the season ; the 
low situation of the town; accumulation of animal and ve- 
getable matter in the gutters, which being obstructed form- 
ed a mass of corruption $ a part of the town being construct- 
ed of wooden houses, built upon large log frames, filled in 
with small wood, and many of them not filled in at all, but 
serving as receptacles to all manner of filth of the poor who 
lived in them, and who, being mostly foreigners, used large 
quantities of beef and fish. 

The noxious influence of the marsh miasmata from the 
borders of Onondaga lake, (N. Y.) are related by Dr. Van- 
dervoort, in his essay on the analysis cf the Ballston mineral 

* See Dr. Ffirth's Account of his Voyage to Batavia, in Dr. Cox's Phila- 
delphia Med. Museum, Vol. I. p. 48, et seq. 

t Webster's Collection of Papers on Bilious Fever, p. 1SG, 



64 Remote Causes of Fever. 

waters. " The marsh effluvia," he observes, " in this west- 5 
ern territory, in many places, and particularly in this place, 
operate so powerfully on the human body, as to induce a 
paroxysm of an intermittent in the course of four or five 
hours, and frequently death the seventh day. From ocular 
observation in these marshes, it appears that the poisonous 
effluvia are generated from the putrefaction of vegetable 
matter, which, in its resolution, undergoes certain changes, 
which produce this noxious air. It is also evident that this 
does not operate where the marshes are inundated." 

In the account of Mr. Andrew Eilicott's voyage down the 
Ohio river, in the month of November, 1796, the following 
facts are related. 4 * Marry of the inhabitants (of Galiipolis) 
this season fell victims to the yellow fever. The mortal ca- 
ses were generally attended with black vomiting. This dis- 
order certainly originated in the town, and, in all probability, 
from the filthiness of the inhabitants, added to an unusual 
quantity of animal and vegetable putrefaction, in a number 
of small ponds and marshes within the village. The fever 
could not have been taken there from the Atlantic states, as 
my boat was the first that descended the river after the fall 
of the waters in the spring ; neither could it have been taken 
from New-Orleans, as there is no communication at that sea- 
son of the year up the river : from the latter to the former 
of those places, moreover, the distance is so great that a boat 
could not have time to ascend the river after the disease ap- 
peared that year in New-Orleans, before the winter would 
set in.' 5 * 

It appears from the account given by the Rev. Azel Back- 
us, in a letter to Dr. E. H. Smith, of New- York, that the 
epidemic which occurred in the town of Bethlehem, Con- 
necticut, in the year 1750, and which the neighboring phy- 
sicians called the plague, from the severity and mortality 
which marked its progress, was occasioned by the letting 
out of the stagnant water of a pond, that had been made to 
accumulate in the valley, for the purpose of destroying a 
growth of small vegetables. u With its stream," he ob- 
serves, '* the pestilence issued, which carried off between 
thirty and forty of the most hale and robust inhabitants."! 

Facts relative to the Black Vomit, Dysentery, <yr. as they' 
occurred in Mifflin County, Pennsylvania, during the hot 
zoeather of 1 797 '98 and '99. By Dr. William Harris.% " It 
is now twenty-five years," says the above mentioned au- 

* Steam-boats "were rot then in use. 
t Med. Repos. Vol. IV. p. 74. 
% Med. Repos. Vol IV. p. 105-&. 



Remote Causes of Fever, 05 

ihor, "since the first settlement of the country, notwith- 
standing the ponds of water, which daring the whole sum- 
mer have been kept full, the inhabitants have enjoyed good 
health till within these three years. The water is now ex- 
posed to the rays of the sun, and becomes nearly dried up 
towards the latter end of summer. It is in many places co- 
vered with a greenish scum, from whence arises a very un- 
pleasant smell. The consequence is dysentery, intermit- 
tents, and highly malignant febrile complaints, which in 
some instances prove mortal in forty-eight hours, and three 
days, having every symptom as described by medical au- 
thors, of the pestilential disease, or yellow fever, of New- 
York and Philadelphia. In the year 1797, it was as fatal 
in Milesborough, which lies upon the Bald Eagle Creek, 
according to the number of inhabitants, as it was in Phila- 
delphia in 1793. A large pond of water stood within the 
neighborhood of the town. The season being very dry and 
warm, the water, which before was shaded by trees, was 
now exposed to the sun, and was, in a great measure, dried 
up. The pond abounded with putrefying vegetables, the 
stench of which proved very disagreeable. Few in the 
town escaped sickness of the most malignant kind, which 
continued through the months of August and September. 
The pond has since been drained off, and the inhabitants 
are as healthy as usual." The same author remarks, page 
106 of the work above referred to, that many vomited a 
dark, filthy, brown substance, and sometimes nearly as dark 
as ink, which wbs so offensive as to cause nausea, and even 
vomiting, in the attendants. 

We are informed by Dr. John Scott,* that between the 
years 1792 and 1796, a gentleman, a few miles above Ha- 
verstraw, New- York, began to erect a furnace and forge in 
the mountains, for which purpose he built a dam across a 
large stream of water, and overflowed an extensive tract of 
land ; small houses were erected for his laborers, who car- 
ried on the work with vigor until autumn, when the pond, 
from the heat of weather, became dry, and his laborers were 
soon after attacked with a malignant fever, which proved 
fatal to most of them ; the few survivors fled, and the work 
remains abandoned. 

A malignant fever originated in the town of Greenfield, 
Saratoga county, (N. Y.) in the year 1797, in consequence 
of the erection of several mills in the town, which caused 
much land to be overflowed. In the fall subsequent to this 

* See Med. Repos. Vol. X. p. 240. 
I 



06' ^Remote Causes of Fever. 

erection, the water became dried up, and whole families 
were seized and carried off with a malignant bilious fever. 
This fever was attended witli the same symptoms that char- 
acterized the yellow fever of the same season in the city of 
New- York. The succeeding years, the new. ponds were 
emptied every May, and not filled till fall, and their malig- 
nant fevers visited them no more. 

The following fact is communicated by Dr. Watkins, from 
his personal knowledge.* There is a village called New 
Design, about fifteen miles from the Mississippi, and twenty 
from St. Louis, containing about forty houses, and two hun- 
dred souls. It is high ground, but surrounded by pond>. In 
1797, the yellow fever carried off forty- seven of the inhabi- 
tants, or more than a fifth. No person had arrived at that 
village from any part of the country where this fever had 
prevailed, for more than twelve months preceding. Our 
informant resided in the village at the time ; and having 
seen the disease in Philadelphia, he declares it to be the 
same that prevailed at New Design. He also mentions an 
Indian village depopulated by the same disease two or three 
years before. 

Dr. Warren, in a letter to Dr. Eliphalet Pearson, descri- 
bing the yellow fever of Boston, says,t '■' Having almost eve- 
ry fall, seen a considerable number of cases, very similar to 
the above, not excepting the black vomit, nor the yellow 
skin, together with other circumstances usually attendant on 
fevers of this denomination, I have been induced to believe, 
that the disorder in question was no other than what has, 
moie or less, prevailed here every year, and is what is pro- 
perly termed a bilious remittent fever. That it originated 
from noxious substances, exhaled into the atmosphere from 
putrefying animal and vegetable substances, or both, is ex- 
tremely probable, from the places in which it was most 
prevalent. 5 ' 

Dr. Drisdale, in his account of the yellow fever of Balti- 
more in 1794, says, it was impossible to ascertain any means 
by which the yellow fever could have been imported ; and 
reasonably imputes it to the. existence of the black, putrid, 
and offensive water under the floors of those stores where 
the sick resided, and to putrid exhalations from the dock and 
from an extensive marsh when the north wind prevailed.}: 

A fever of a malignant character, and such as Dr. Hamil- 
ton and Dr. Alibert have denominated the malignant inter- 

* Med. Repos. Vol. X. p. 74. 

tlbid, Vol. I. p. 135. 

£ Cox's Philad. Med. Mus. Vol. t. 



Remote Causes of Fever* G7? 

mittent, originated in the town of Sheffield, Massachusetts, 
on the Housatonic, in the years 1793, '94 and '95, from the 
putrefaction of the neighboring morasses.* The banks of 
the river were interspersed with coves and extensive marsheg 
of stagnating water, in addition to which were two mill dams, 
which caused a considerable tract of country to be over- 
flowed with water, and which drying up as the heat of sum- 
mer increased, exposed a vast bed of offensive and putrefy- 
ing animal and vegetable matters. The consequence was 
fever of a malignant aspect, in some cases attended with 
yellowness of the skin. 

I have annually observed a number of cases resembling 
the fever above spoken of, less malignant than the bilious 
remittent, but much more so than the ordinary intermittents 
©f temperate climates, and which, if neglected, soon assu- 
ming the character of the bilious remitting or yellow fe- 
ver. A similar fever occurred in 1779, in Ontario county, 
(N. Y.) Its remedies were plentiful purging at the com- 
mencement with calomel and jalap, and the liberal use of 
the bark as soon as the remissions would admit of its exhibi- 
tion.! 

I am aware that it has been attempted to be shown by 
some physicians, and particularly by Dr. William Ferguson, 
that endemic and yellow fevers arise from something differ- 
ent from putrefactive exhalations, from the circumstance of 
their prevailing in certain dry seasons and situations, where 
no putrefactive sources apparently existed. In answer to 
this, I will subjoin the following observations of Dr. Rush. 
"Dr. Gordon informed me. J that five hundred persons died 
of the yellow fever in Berbice, (Surrinam,) between July, 
1804, and May, 1805, during which time there fell not quite 
three inches of rain. The earth, in this case, was every 
where dry and parched. Bilious fevers, Sir John Pringle 
tells us, occur in a part of Holland in very dry seasons, but 
in these cases the earth cracks, and putrid exhalations es- 
cape from water which stagnates below its surface. The 
same cause which produced these fevers in Holland, proba- 
bly induced the fever at Berbice, mentioned by Dr. Gor- 
don, as also all such bilious fevers as appear under the same 

* See Dr. Buel's Letter in Webster's Collection of Papers on BiliousFe- 
vers, p. 53 & seq. 

t The attention of physicians was first called to the consideration of this 
form and variety of fever from the accurate description of Morton ; and 
more recently the inquiry has been industriously and ably conducted by 
Torti, Lautter, VVerlhof, Senac and Cleghorn. 

X Inq, and Ob?. Vol. IV, p. 181. x 



63 Remote Causes of Fever. 

circumstance of apparent absence of moisture and putrefac- 
tion." In further illustration of this fact, I would observe, 
that in the months of June and July, in 1823, during a hot 
and dry spell of weather, a high grade of bilious lexer pre- 
vailed in various parts of the piairies in Alabama. The soil 
in those parts of the country where the fever made its ap- 
pearance, was exceedingly rich, deep and black; but ex- 
cept in the hollows, the surface was dry, parched, and 
cracked open. Upon removing this crust, however, which 
did not exceed half an inch in thickness, the soil was per- 
fectly moist beneath; and from the offensive smell which 
issued from it, and which was very perceptible after sun- 
set, appeared to be in an active state of putrefaction. 

It may be asked if the bilious, endemic or yellow fever, 
is produced by heat and putrefaction, why does it not occur 
every season in places which have once been visited by it? 
To this I would answer, that certain seasons and circum- 
stances are more favorable than others to the decomposition 
of animal and vegetable matters, and to the developement 
of the semina of bilious fever. It is not contended that pu- 
trefaction, in every instance and situation where it may ex- 
ist, will necessarily and inevitably give rise to bilious fever. 
But it is maintained, and without the fear of contradiction, 
that wherever this disease has prevailed in our country, 
there have existed in the vicinity of its prevalence the ma- 
terials and requisites of putrefaction and decomposition in 
no inconsiderable degree. 

It has been remarked by Lancissi and others, that the 
mixing of the salt water with the fresh along the sea coast, 
and places accessible to the tide, is peculiarly favorable to 
putrefaction, and the consequent production of disease. — 
The experiments of Sir John Pringle would seem to prove 
that a small proportion of salt promotes instead of retarding 
putrefaction. But as it respects the mixing of salt and fresh 
water in bays and harbors affected by the tide, the truth of 
the position, I believe, has not been proved by general ex- 
perience, nor has it been found that putrefaction in such 
places is more rapid than in fresh water ponds and marshes. 
It is well known, however, that in all large sea-ports there 
is a very considerable accumulation of filth about the docks, 
occasioned by the wash of the cities, the lading and unlading 
of vessels, which corrupts and infects the air from its own 
* intrinsic tendency to putrefaction, and not from any adven- 
titious agency of salt water. It was well observed b) For- 
tunatus Fidelis, that " some unknown mischief is engender- 
ed in places along the shores of harbors. For there many 



Remote Causes of Fever, 09 

vessels are moored, all their nastiness is accumulated, and 
the excrements of cities deposited. Wherefore, although 
the maratime aspect of the place promises something highly 
encouraging to health, yet it is all marred by this horrible 
mixture of things.' 5 The fact would seem to be, that the 
pure muriate of soda possesses, in any quantity, an antisep- 
tic property. Liverpool salt, however, prepared as it is by 
artificial evaporation, possesses many impurities foreign to 
the preserving virtues of the pure muriate of soda. And 
we are informed by Dr. Percival, that Sir John Pringle told 
him "he had long believed the septic quality of the sea salt, 
as employed in his experiments, was owing to some hetero- 
geneous substance blended with the article, and not to any 
putrescent quality in the mere muriate of soda, or pure sea 
salt itself." 

Some have pretended to deny the pernicious influence of 
effluvia arising from the putrefaction of animal matter ; and 
it has been brought forward as an argument in favor of this 
opinion, that butchers, tanners, oil sellers, or dealers in oil, 
the manufacturers of ammonia, &c. remain healthy notwith- 
standing the offensive effluvia with which they are surround- 
ed. Such instances of exemption, howerer, can furnish no 
conclusive argument that such occupations are in themselves 
peculiarly healthy, any more than the argument, that be- 
cause an unusual quantity of spirits does not produce intox- 
ication in an habitual dram drinker, it is therefore destitute 
of any inebriating quality whatever; for we know that long 
familiarity with, and exposure to, otherwise noxious agents, 
fortifies the body, by custom, against their pernicious influ- 
ence. In this way are we enabled to account for the ex- 
emption of the butchers from the yellow fever which pre- 
vailed in Philadelphia in 1793. '•' It has been often remark- 
ed," says Van Swieten, " that workmen employed in tan- 
neries, in the preparation of skins, intestines, animal glu- 
ten, &c. who continually breathe an air charged with pu- 
trid exhalations, enjoy good health, while strangers cannot, 
with impunity, approach the place where these foetid sub- 
stances are manufactured."* 

One of the most conspicuous abettors of the opinion, that 
animal putrefaction is exempt from any injurious conse- 
quences in the production of disease, is Dr. Chisholm, an 
advocate, also, for the contagion and imported infection of 
the yellow fever. It appears that Dr. Hosack is likewise 
inclined to this opinion. Though it can hardly be suppo- 

* Van Swieten. Comment, in Boerhaave. Alph. 



70 Remote Causes o/Fevev'. 

aed that every animal whose carcass rots upon the surface 
of the earth, should occasion a pestilential atmosphere in 
its vicinity, yet instances upon a larger scale are too nume- 
rous to admit the conclusion, that the putrefaction of ani- 
mal matter has no noxious or morbific tendency. This 
opinion of Dr. Chisholm and Dr. Hosack, is akin to that of 
Alexander Benedictus, whom Lancissi sty les the first patron 
of stinks, and adviser of their remedial operation. " Some 
have entertained the notion,- 5 says Lancissi, '' that the efflu- 
yia of corrupted substances had no manner of noxious ope- 
ration, because they had read that these very agents were 
sometimes considered as remedies in some pestilential sea- 
sons. Thus Alexander Benedictus states, " that he had 
heard from a merchant of Candia, that all the dogs were 
killed during the prevalence of a violent plague, and by or- 
der of the physicians thrown about the streets. The air 
was soon filled with their corrupting exhalations, and their 
r medial operation immediately restored the place to health." 
Very near akin to this story," says our author, " is another 
related by George Pictorius, "who heard a man from Uto- 
pia affirm, that in an epidemic plague, nothing was more 
wholesome and excellent than three times a day to snuff up 
the fumes of a privy, or of a sheep-fold," So also Joseph 
Quercetanus adduces the case so familiar to the people of 
Paris, to wit, that of the nastiness of their streets being con- 
sidered by many physicians as checking the putrefactive 
taint of their atmosphere. Nor are there wanting other au- 
thorities from very serious writers, collected by Gaspar a 
Rej^s, by which it is shown that bad smells are sometimes 
valuable auxiliaries of nature. But we have nothing to ap- 
prehend in making a full reply to these observations. As to 
Alexander and Pictorius, the experiments were not made 
by themselves, but told on the credit of others. The former 
got his story from a Cretan merchant, and the latter from 
an Utopian traveller." In relation to this subject, Lancissi 
makes the following remark. " What satisfies us of the 
ease wi.h which wise men commit blunders, when they 
start wrong, is this, that our opponents have mistaken the 
antidote for the poison, and the remedy for the matter of 
mischief."* 

The noxious influence of animal putrefaction will be bet- 
ter illustrated by a few examples. 

We are informed by Alexandrianus, Diodorus Siculus, 
and others, that plagues have arisen from the putrefaction 

* Translation of Lancessi's Work by Dr. Mitchill, Med. Repos. Vol. XIII; 
p. 126. 



Remote Causes of Fevet. 71 

of dead bodies after battles. In confirmation of this fact, 
we are referred by Diemerbroeck (De Peste) to Hieroni- 
mus, Augustinus, Sobalius, WoMius, Angelus, Parasus, and 
Agricola. Diemerbroeck, speaking of his own experience, 
says that a very bad malignant fewer was produced by the 
putrefying remains of 8000 Germans, together with horses 
which were left slain on the plain of Juliers, in the summer 
of 1642, and that a similar disorder immediately appeared 
after the severe engagements between the Austrians and 
Swedes, owing to the neglect of burying the dead. 

Forestus relates that a dead whale cast upon the shores 
of Holland, occasioned an extensive pestilence in Egmont. 
The same author mentions a fever which originated in Ve- 
nice, in his time, from the putrefaction of a quantity of smaSi 
fishes, which abounded in that part of the Adriatic. And 
Paraeus informs us that a severe plague which spread over 
the whole extent of Tuscany was produced by allowing a 
whale to putrefy, which had been thrown upon the shore. 

The circumstance, that on other occasions dead bodies 
have putrified upon the ground without producing any pes- 
tilential disorder, will not invalidate the conclusion, that 
such effects have in other instances been occasioned by 
them ; and in these exceptions, the want of exposure to the 
exhalations, and the season of the year, may have been the 
cause of their not proving equally injurious. 

We are informed by Dr. Lind,* that at Bencoolen, the 
diseases that always raged violently during the month of 
October, are occasioned by dead fish and other animals led 
by the Ganges ; and that the unhealthiness of Gambrooa 
arises from vast quantities of little fishes left upon the shore, 
which soon become putrid, and contaminate the air. 

It is related by historians, that in the year of Rome 628, 
and B. C. 126, a most destructive pestilence was occasion- 
ed in Africa by dead locusts : A strong east wind brought 
the swarms of these animals towards Numidia and Utica in 
such astonishing multitudes, that they devoured every leaf 
of vegetation, and even the bark of the trees. A south wind 
drove and precipitated them into the Mediterranean, and 
beiii£ washed on shore in the hot season, they putrefied and 
caused a most dreadful plague. We are told that 800,000 
persons perished in Numidia, 200,000 on the sea-coast of 
Carthage, and 30,000 of the Roman troops. f It is said by 

* Lind on the Diseases incidental to Europeans in Hot Climates, 
t Livy Epit. 60 Orosius lib. v. p. Diac. August. Hi3t. £13. The reader of 
faored writ will call t© mind, tho Mosaic &CGoaat ©f the plagues %f fecusts in 



It Remote Causes of Fever. 

Orosius, that the effects of this pestilence were not confined 
solely to the human species ; such was the corruption of 
the air, that a general mortality of birds, cattle and wild 
beasts, marked the progress of its destructive ravages, and 
served to increase the dreadful calamity and desolation. 

Dr. Monro gives an account of a pestilential fever, or 
plague, which appeared among the soldiers encamped about 
Warburgh in 1760, occasioned by the putrefaction of an in* 
finite number of dead horses and men? scarcely covered 
with earth.* 

A barbarous stratagem is related by Mr. Gibbon, in his 
account of the Saracens, when they overran Africa : One 
fortified place was impregnable to their warlike machinery ; 
and as they did not choose to starve it to compliance by a 
siege, they therefore gathered all the inhabitants of the 
country round about, and murdered them, and ieft the dead 
bodies round the walls; in consequence of which a violent 
fever, or plague, soon obliged the place to submit, after 
most of its defenders were dead, and the remainder debili- 
tated by sickness and fatigue. 

M. De Lassone gives an account of a malignant fever 
and dysentery, produced by the putrefaction of animals that 
had died of an epidemic disease in Paris and its environs. 
By being but slightly and imperfectly covered with earth, 
putrid effluvia were evolved, and produced disease among 
the neighboring inhabitants ; which ceased, upon the dead 
bodies being effectually covered with lime and earth. t 

It is reported by Lancissi, that near Rome is a place 
where the carcasses of horses and mules are carried to be 
skinned and cut into meat for feeding hounds and cats. — 
When this business is negligently performed, and the bowels 
and limbs thrown into the river lodge in the nooks and cor- 
ners of the bank, the neighboring inhabitants immediately 
suffer from the corrupted condition of the air, and become 
afflicted with malignant and pestilential fevers. 

Egypt, in the time of Pharaoh, B. C. 1491 ; which we are told was preceded 
by a strong east wind, which continued to blow for a day and a night, and in 
the morning brought the locusts in such myriads, that " before them there 
were no such locusts as they, neither after them shall be such. For they 
covered the face of the whole earth, (Egypt,) so that the land was dark- 
ened ; and they did eat every herb of the land, and all the fruit of the trees 
which the hail had left ; and there remained not any green thing in the 
trees, or in the herbs of the field, throughout all the land of Egypt."-- - 
Genesis, chap. 10. 

* Monro on the Diseases of the Army, Vol. I. p. 226. 

t Med. Comment. Vol. VIII. p. 58. 



Remote Causes of Fever. 73 

When the vapors of animal putrefaction are pent up and 
confined in a narrow space, they are thereby rendered more 
concentrated in their virulence and more fatal in their ope- 
ration. In illustration of which, the following instances 
may be considered as striking and instructive. 

We are informed by Mr. P. C. Varle, that in the summer 
of 1783, M. Faure, a merchant of Norbone, in Lower Lan- 
guedoc, in France, bought a house which had been previ- 
ously occupied as an anatomical hall ; and, being desirous 
of having a cave dug in the cellar, employed three men to 
do it. In digging, they came to the wall of a necessary, 
which had been the common receptacle of the remains of 
human subjects, and which was covered, to prevent detec- 
tion : and on extracting a few of the stones with their picks, 
an offensive putrid matter rushed through the aperture; 
and such was its virulence, that it produced instant suffoca- 
tion. M. Faure, corning to see the workmen, descended 
but two or three steps before he fell senseless. The neigh- 
boring people, perceiving the putrid smell, went to the 
house > and of nine that entered to bring out the sufferers, 
six died. M. Faure was recovered from the first impress- 
ion, but died four days afterwards ; and the unfortunate la« 
borers survived but a day or two. 

In Pierre Cotte's Treatise on Meteorology, he gives the 
history of the case of a grave-digger in 1773, who by acci- 
dentally opening a coffin that had been buried a year be- 
fore, was suddenly killed by the vapor that issued from h. 
He further adds, that in the same year? during the time of a 
funeral, there arose a vapor from the coffin of a person re- 
cently buried, and of 120 persons who were present, 114 
were taken ill with a putrid fever. A similar occurrence 
is said by Dr. Robertson to have taken place, some years 
ago, in West Linton ; a school boy, getting into anew made 
grave, set about to open the projecting corner of a coffin, 
which as soon as he had penetrated, there issued from thence 
a strong nauseous smell, on which he exclaimed he was suf- 
focated ; on being removed from the place, he recovered 
from the first effects, but was immediately seized with a pe- 
techial fever, of which he died on the seventh day.* A pes- 
tilential fever occurred at Pans, on clearing the burying 
ground belonging to the church of the Innocents. 

It is related by Sir John Pringle, that the greatest number 
and worst cases of jail or hospital fever, were in one of the 

* Robertson on the Atmosphere ami Epidemics, Vol. II, p, 341, 
K 



fl Remote Causes of Fever* 

ships, in which there happened to be two men with morti- 
fied limbs; this accident was not only the means of spread- 
ing the infection at sea, but also in the wards in which they 
lay after their removal.* 

Besides Pringle, Ramazzini, Porteus and others, who 
have written on the diseases incidental to armies, have con- 
sidered the offensive effluvia of the excrement of man and 
beast, as a powerful cause of those putrid diseases which 
often prove so destructive to soldiers in encampments and 
fortified places,! 

To the excessive use of animal food, and to the putrefac- 
tion which took place about their camp, we may reasonably 
ascribe the dreadful plague with which the children of Is- 
rael were afflicted at Kibroth-haUaavt:b, (or the graves of 
lust ;) when, despising the manna that fell from heaven, they 
longed for the luxuries of Egypt and the flesh of beasts.— 
The sacred historians inform us, that " the mixed multitude 
that was among them fe\] a lusting; and the children of Is- 
rael also wept again, and said, who shall give us flesh to eat ? 
We remember the flesh we did eat in Egypt freely ; the cu- 
cumbers, and the melons, and the leeks, and the onions, and 
the garlic : but now our soul is dried away ; there is nothing 
at all, beside this manna, before our eyes." * * * And there 
went forth. a wind from the Lord, and brought quails from 
the sea, and let them fall by the camp, as it were a day's 
journey on this side, and a day's journey on that side, round 
about the camp, and as it were two cubits high on the face 
of the earth. And the people stood up- all that day, and all 
that night, and all the next day, and they gathered the quails ; 
he that gathered least gathered two homers, (240 bushels,) 
and they spread them all abroad for themselves round about 
the camp." In the conclusion of this account, we are in- 
formed by the sacred writer, that "the Lord smote the peo- 
ple with a very great Slaughter."! 

Cases of yellow fever are said to have been produced in 
the West Indies by the putrefaction of a quantity of her- 
rings^ 

An 'occurrence similar to 'the preceding, and from the 
same cause, is related by Dr. Kollock, of Georgia, to have 
taken place in an American frigate, on her passage from 

* Diseases of the Army- p. 68. 
. t la using the phrase putrid diseases, I merely speak in conformity to the 
opinion and phraseology of others ; the doctrine of putridity will be treated 
of hereafter. 

£ Numbers, chap. xl. 

4 Med. Repository, Vol. 111. p. 4G9. 



Remote Causes of Fever. 7d 

Newport to Havana.* And in the Medical Commentaries, 
Vol. VI, p. 248, the reader may find a similar instance re- 
corded. 

The deleterious operation of fecal exhalations, is men- 
tioned by Dr. Mitchill, as exemplified in the blacks who 
were employed in removing those offensive accumulations 
in the city of New- York, in April, 1800. The effects were 
catarrhs, inflammation of the eyes, pains in the bowels, gri- 
ping, tenesmus, bioody stools, or dysentery, to which was 
added a febrile commotion in the constitution, of various 
degrees of violence, sometimes terminating in death. f We 
are informed by the same gentleman, that the inspector 
general of beef and pork in the city of New- York, examin- 
ed, during the summer and autumn of 1799, several thou- 
sand barrels of corrupting meat. (I pass over the Doctor's 
speculations on septic acid.) Of those forty men, thirty- 
eight, the inspector general himself being one, were affect- 
ed with dysenteries, of various degrees of violence, besides 
which, a considerable part of them were affected with ca- 
tarrhal symptoms, nausea and fever.| 

The mortality which took place in the Dutch army, whilst 
it was besieged by the troops of Java, is stated by Bontius 
to have been occasioned by the dead bodies of the soldiers 
which were thrown into the river, and corrupted the waters. 
The air was likewise tainted with the putrefying carcasses 
of men and beasts that had died of famine and wounds, and 
lay unburied in the fields, in consequence of which, a malig- 
nant fever and dysentery were occasioned. § 



* Med. Repos. Vol. IV. p. 1. 

t Ibid, Vol. III. p. 409. 

| Ibid, p. 309-10. 

$ Bontius on the Diseases, Natural History, &c. of the E. Indies. 



76 Origin, <^c. of Endemic Fevir. 



CHAPTER II. 



OF THE NATURE, ORIGIN AND CON 
TAGION OF ENDEMIC FEVERS. 



SECTION 1. 

Of the Nature and Origin of Endemic Fevers. 

These are subjects upon which much has been said, but to 
how little purpose may be learnt from the great diversity of 
opinion that still prevails. It may appear arrogant in me to 
attempt to settle a dispute which has been discussed with so 
much learning and ingenuity by individuals, societies, col- 
leges, and councils ; but as long as facts, common sense, the 
experience and observation of the intelligent and judicious, 
are my authorities and guides, I may reasonably hope of 
gaining the attention of the unprejudiced and impartial, who 
give their confidence and assent, not to the mere adventi- 
tious circumstances of rank, authority and number, howev- 
er imposing, but to the demonstration of reason, and the 
evidence of truth. 

In the preceding chapter, the causes of endemic fevers 
have been pointed out, as arising from the putrefaction of 
animal and vegetable substances, operated upon by heat, 
moisture and exposure to the atmospheric air. To establish 
and illustrate this point, a number of facts were adduced, 
and references made to different authors for a fuller and 
more satisfactory confirmation of these circumstances ; from 
which it appears, that the general agreement of experienced 
physicians has established, as an unquestionable fact, the 
noxious influence of these external and remote causes of 
endemic fever. This may be considered as an important 
step in the progress of medical science, advanced upon sure 
ground, and from which there seems to be no danger of re- 
ceding. 

It will be readily understood, that the results of putrefac- 
tion will be modified in their nature* according to the diver* 



Origin, (y-c. of Endemic Fever. 77 

sity of substances subject to the decomposing process : and 
which will consequently cause a difference in the effects 
which they occasion. A further difference will arise from 
the degree of virulence and concentration in those noxious 
exhalations themselves, as influenced by the degree of heat 
and moisture, and the quantity of corruptible materials to 
be acted upon. The mildest degree of their operation 
seems to be that whereby they occasion catarrh, and slight 
febriJe affections, with disorders of the stomach and bowels ; 
the next, is that of intermitting fever, then mild remitting, 
bilious remitting, yellow malignant, pestilential fevers, and 
plague. Between these extremes there are a variety of 
degrees and modifications of symptoms and appearances; 
but under whatever names the disorders thus produced may 
be known and designated, as there is a similarity in theiF 
causes, so is there an affinity or identity in their nature. 

Where animal bodies are confined in a close unventilated 
apartment, the various excrementitious matters that are 
constantly escaping from them, either by respiration, per- 
spiration, or otherwise, must, by warmth and stagnation, un- 
dergo putrefaction, and in the end be productive of disease .;*" 
but as in this instance the materials operated upon are dif- 
ferent from those of ordinary putrefaction in the open at- 
mosphere ; so likewise, are the morbid symptoms resulting 
therefrom. We know that the small and close apartments 
of a prison, which have been a long time inhabited by their 
unlucky inmates, become very offensive to the smell from 
the degree of putrefaction which has taken place in the filth 
of their confined habitation : and instances are recorded of 
persons being suddenly infected with disease from exposure 
to such noxious effluvia, though the health of the prisoners 
themselves had not been thereby deranged. The exemp- 
tion of the latter, and the infection of the former, are to be as- 
cribed to the influence of habit, diminishing the sensibility of 
the system to stimuli and agents gradually increasing, and 
habitually and constantly applied. The circumstance of the 
butchers in Philadelphia remaining uninfected during the 
mortality of the yellow fever in 1793, is to be explained 
upon the same principle. This circumstance is illustrated 
upon a larger scale among the native inhabitants of hot cli- 
mates and unhealthy situations, who are much less subject to 
disease than emigrants and strangers lately arrived : in the 
former, the fever, where it occurs, assumes the character of 

* This putrefaction of perspirable matters is exemplified in the offensive 
smell which a pocket handkerchief soon acquires in the summer season 



78 Origin, fyc. of Endemic Fever. 

a mild remittent, whilst in strangers it puts on the terrific 
and malignant aspect of the bilious yellow fever. 

Upon the subject of contagion, we know that some dis- 
eases are contagious, and that others are not contagious ; the 
small pox. chicken pox, measles, lues, &c. belong to the for- 
mer denomination; scrofula, rickets, diabetes, gout, &c. to 
the latter. But there is a family of disorders, which some es- 
sayists contend are contagious, and others aver with equal 
confidence that they are not contagious ; besides which, 
there are still others who hold, that the diseases in dispute 
are, or are not contagious, according to circumstances. Any 
disease that may be communicated from one person to an- 
other, whether by contact or through the medium of an in- 
tervening substance is understood to be contagious. Thus 
whether the disorder is received from inspiring the breath of 
an infected person, or by smelling or wearing the clothes of 
one who has died of the disorder, it is equally the effect of 
contagion. But as in epidemics it is impossible to trace 
every case to either of these causes, it has been maintained 
by some, that the infection introduced into a town or coun- 
try propagates itself by the power of fermentation ; that is, 
by converting a portion of the atmosphere to its own nature ; 
but as without some limitation, such an effect would ex- 
tend itself ad infinitum, it is supposed that a certain condi- 
tion of the atmosphere was necessary to this process; just 
as warmth and humidity in flour are required to give efficacy 
to the fermentative quality of leaven, enabling it to commu- 
nicate its own properties to the whole mass, i^gain, say 
ihey, the effect must be limited to the contagion of a par- 
ticular disease ; thus if the atmosphere is disposed to the 
fermentation of the yellow fcvvr* it would be in vain and 
without effect to introduce the contagion of the small pox or 
plague ; nor, if the atmosphere was disposed to the fermen- 
tation of the plague, would the introduction of the conta- 
gion of the yellow fever have any influence in checking its 
progress or changing its action. For both the propagation 
of the plague and yellow fever, it is contended that a foul 
air is necessary ; but then this foul air must be of a particu- 
lar quality, so as to dispose it either to a pestilential fermen- 
tation, or a yellow fever fermentation. In this way they 
endeavour to account for the prevalence and propagation 
of the yellow fever, &c. without having recourse to the pro- 
cesses of animal and vegetable decomposition, as produced 
by heat and moisture. Thus it appears that an unknown 
variety and concurrence of circumstances are required for 
the production of these dreadful epidemics, and that though 



Origin, c£*c. of Endemic Fever. 7S 

every other cause conspire, yet if the fatal leaven is not 
applied no danger can possibly arise. Thus ten thousand 
dead horses, and filth of every description, operated upon 
by a summer's sun, may taint and infect the air with their 
suffocating and offensive stench, yet if the leaven is not in- 
troduced no evil consequences need be apprehended. 

From this opinion of atmospheric fermentation, however 
plausible and satisfactory it may be to its advocates and sup- 
porters, T beg leave to differ: 1st, because the supposition ap- 
pears to be entirely gratuitous and unphilosophical ; we have 
a notion of the fermentation of vegetable juices, of flour 
and water, &c. ; it is, however, the vegetable matter in these 
substances undergoing partial decomposition and forming 
new combinations, that causes such fermentation ; but we 
have no instance of the fermentation of gaseous substances ; 
oxygen, hydrogen, nitrogen and carbonic acid may be mix- 
ed and mingled in any quantities and proportions, yet their 
qualities remain the same ; no fermentation, either vinous, 
acetous or putrefactive takes place: 2d, because the intro- 
duction of such a supposed ferment can seldom be traced 
or ascertained, even by the advocates of this hypothesis 
themselves : 3rdly, because other circumstances are suf- 
ficient to account for the production of endemic, yellow fe- 
ver, or plague without the supposed influence of this undis- 
covered and impalpable ferment and leaven. For if a foul 
or impure atmosphere is necessary, even according to this 
doctrine of fermentation, for the propagation of these dis- 
eases, how is this impurity of the atmosphere to be account- 
ed for, unless from animal and vegetable decomposition, as 
occasioned by heat and moisture i* but if it can be shown 
that the yellow fever has ever originated in the midst of win- 
ter, when all decomposition was suspended, it will then be 
conceded that other states of the atmosphere, besides that 
produced by putrefaction may give rise to this disease : but 
the admission of this impure state of the atmosphere, which 
even the doctrine of fermentation supposes, renders the 
supposition of the introduction of any extraneous leaven en- 
tirely superfluous. For whether is it easier to imagine the 
adventitious presence of this particular leaven, or to ac- 
count for the ditferent appearances and modifiraiior.s of the 



* That other irh purities of the Mtftp&i ber> >iq adspeMentfaf those 

caused by putrefaction id readily adrjiHted: tins seems tohave been the case 

in the production of the winter or spotted fever of the northern states. 

This fever and its causes, however, do not tali vnthin |he cope of the 
present subject of inquiry. 



80 Origin, <f/-c. of Endemic Fever, 

disease from the different degrees and combinations of heat, 
moisture and corruptible materials ? 

If it be contended that the yellow fever is a specific dis- 
ease, invariably marked by a peculiarity of symptoms, it 
may be answered that no two authors have ever given the 
same account of this disorder, or discribed the same set of 
symptoms; but represent it as being so diversified by dif- 
ference of climate and season, as never to appear under the 
same form. The yellowness is admitted by most authors 
not to be characteristic, and the other symptoms are equal- 
ly variable and uncertain. Even admitting the yellow fever 
to be specific in its nature, it is not more so than a tertian 
intermittent, which is universally considered as arising from 
noxious exhalations. If ajerment is necessary for the pro- 
duction of yellow fever, why is it not equally necessary for 
that of the fever and ague ? If the latter is produced with- 
out the agency of any such fermentation, what reason have 
we to suppose the existence and operation of any such prin- 
ciple in the production of the former ? It would be a mere 
waste of time to attempt the further refutation of an opin- 
ion so perfectly visionary and unsubstantial. 

The exotic parentage and imported contagion of the yel- 
low fever is another opinion necessarily maintained by the 
advocates of the preceding doctrine of leaven and fomen- 
tation : who contend that the contagion is imported from the 
East Indies, Turkey, Africa, and the West Indies, by suc- 
cessive propagation : but what ifthe inhabitants of Turkey 
and Africa should maintain that it was imported to their 
country from America, and should enforce a system of quar- 
antine against our vessels, as we do against those of the 
West India Islands? They could certainly trace the intro- 
duction from America with equal facility as our Cis-Atlan- 
tic fraternity scent the infected breeze from the shores of 
Africa. - 

And what are the circumstances in those remote countries 
necessary to the origin and prevalence of epidemics, as the 
yellow fever and plague ? These have been already point- 
ed out under the head of causes. It was there shewn that 
heat, moisture and putrefaction were invariably the antece- 
dents and attendants on those fatal disorders. What but a con- 
currence of similar circumstances is necessary to produce 
similar effects in any situation ? The effects will be in propor- 
tion to the causes: wherever the degree of temperature 
is highest, concurring with a greater proportion of moisture 
and corruptible materials, there also will prevail the most 
malignant disorders. I speak of the epidemics of summer 



Origin fyc. of Endemic Fever, 81 

and autumn, and such as arise from an obvious concurrence 
of the external causes already mentioned. We according- 
ly find that wherever the yellow fever, as it is improperly 
called, has prevailed in our country, there has been a re- 
markable combination of the circumstances which we have 
noticed. A defective police; the accumulation of filth; a long 
continuance of hot weather, during which the pestilential 
atmosphere was not dissipated by salutary breezes, produc- 
ed the yellow fever in Philadelphia in 1793. Similar caus- 
es concurred to give rise to the same disorder in New York 
and various other places at subsequent periods. 

The fact is that the yellow fever, or to speak more prop- 
erly the bilious malignant hver t is the natural offspring and 
production of a widely extended country; comprehending 
in its circle the torrid and considerable portion of the tem- 
perate zone: viz. Africa, the East and West Indies, the 
South Europe and Asia, a considerable portion of South 
America, and its extent and prevalence in various parts of 
North America are too well known to require to be partic- 
ularly mentioned here. Wherever its essential causes, heat, 
moisture and corruptible materials exist in the greatest de- 
gree, there will bilious and endemic fevers prevail with 
the mo;t malignant fatality. The more temperate or 
cold the climate, the less subject will it be to bilious fever ; 
and on the contrary, the hotter the climate, and the more 
marshy and abundant in putrefying materials, the more sub- 
ject will it be to this disease. These are truths which may 
be said to be as immutable as the laws of nature. Was 
the yellow or bilious fever ever known to exist in the frigid, 
zone, in Lapland, Sweden, Norway, Denmark or Green- 
land ? No, and for an obvious reason, because the heat of 
those countries is never sufficiently great or long continued 
to produce the necessary degree of putrefaction and decom- 
p»'ition. As we approach the equator, we observe the dis- 
ease more frequent and malignant ; until arriving at the 
tropicks, we there find it existing as a permanent epidemic. 

Having shown the insalubrity of low and marshy situa- 
tions, and of towns and places abounding with putrescent 
and corruptible materials, it scarcely appears necessary to 
point out the circumstances and situations opposed to the 
evolution of noxious effluvia, and the consequent produc- 
tion of fever. The peculiar healthfulness of high, dry and 
hilly situations, remote from marshes, rivers, and stagnating 
waters, has been universally observed, as well in the south- 
ern portion of the United States, as also in the West India 
islands and the tropical parts and sea coast of South Araeri- 



82 Origin, fyc. of Endemic Fever, 

ca. So well are the inhabitants of towns, cities and settle- 
ments situated upon the sea coast and rivers in the United 
States convinced of this fact, that families of competency 
and fortune in unhealthy places, annually leave their winter 
residence upon the approach of hot weather and retire to 
the hills in the country, remote from stagnating water and 
sources of putrefaction, and return again in the fall, after 
the appearance of frost has suspended the process of de- 
composition, and purified the atmosphere. In this way they 
avoid the infectious sources of disease. 

The successive and gradual change in the salubrity of 
the climate of St. Domingo, in receding from the sea-coast 
to the more interior and hilly parts of the island, is well re- 
presented by Dr. Jackson, who observes,* that " In most 
situations on the sea-coast, the character of the endemic is 
strongly marked ; in the wet or unhealthy season, the febrile 
form of disease chiefly prevails ; in the spring and earlier 
part of summer, more particularly under slight and accident- 
al rains, diarrhoea is not uncommon. In higher situations, 
on the first chain of mountains, intermittents or diarrhoea 
are frequent in wet weather, sore legs are troublesome at 
other times. In situations still more interior, on the moun- 
tains, or in the valleys lying under the second chain of moun- 
tains, intermittents and diarrhoea, though occurring occa- 
sionally, become gradually more rare ; sore legs take their 
place, and appear actually to be the endemic disease of that 
tract of country. In the highest situations, or on the cen- 
tral ridge, neither fevers, fluxes, nor sore legs are known, at 
least they occur so seldom as not to deserve notice." The 
same author remarks,! that the form and degree of endemic 
disease follows nearly the same rule in Jamaica, as in St. 
Domingo. The character of endemic fever is strongly 
marked at Spanish Town and Kingston ; diarrhoea has its 
season, but sore legs are of rare appearance. At Stot*iy 
Hill, intermittents and diarrhoea occur sometimes, but the 
fever is seldom of a dangerous kind ; sore legs are frequent, 
and of difficult cure. At Maroon Town, ievers and fluxes 
are not often seen ; but sore legs are not uncommon. It 
may be presumed, though not yet ascertained by trial, that 
in still higher situations, sickness and sore legs will be ar 
little known, as they are on the central ridge of the moun- 
tains of St. Domingo." The healthiness, in the West In- 
dies, of hilly situations, remote from marshes and sources of 

* Outline of the History and Cure of Fever, p. 90. 
i Ibid, p. 93. 



Origin, £c. of Endemic Fever. 83 

putrefaction, is also attested by Dr. Davidson, in his letter 
to Dr. Rush.* " I have mentioned (says the Dr.) an in- 
stance of the remarkable good health which the 66th regi- 
ment enjoyed at St. Vincents for several years, upon a high 
hill above the town, removed from all exhalations, and in a 
situation kept at all times cool by the blowing of a constant 
trade wind. They did not lose, during eighteen months, 
above two or three men." 

As to the degree of northern latitude to which yellow fe- 
ver has extended, in the United States it has prevailed in 
Boston, situated in lat. 42, 22, N. and in the various sea- 
ports to the south of that city on the coast of the United 
States. Endemic fevers, of a malignant character, origina- 
ting from heat, moisture and putrefaction, in European coun- 
tries, have been mostly confined to the coasts of Spain, Italy, 
the islands of the Mediterranean, the sea-ports of Greece, 
and the southern coast of the Black Sea, scarcely exceeding 
the 42d degree of north latitude. 

I am aware, however, that fevers of a malignant nature, 
approaching nearly in character and degree to the yellow 
fever of the United States and the West Indies, have, on some 
occasions, prevailed as far north as the 52d degree of north 
latitude, at Walcheren, Lynn, Breda, Delft, in different parts 
of Flanders, Hungary, and other districts and situations 
where the land is low, wet, and abounding with stagnating 
water. In such places, an unusual continuance and degree 
of warm weather through summer and autumn, may produce 
intermitting and remitting fevers of an aggravated and ma- 
lignant character, differing only in degree from the yellow 
fever of North America and the West Indies. Thus the 
fever which prevailed in Lynn in 1779, and the five follow- 
ing years, was considered by Dr. Robert Hamilton to be of 
the same nature as the yellow fever of the West Indies as 
described by Dr. Hillary; the tertian of Minorca by Cleg- 
horn ; and the remitting fever of Bengal by Clark. 

In the production or origin of yellow fever, it will be pro- 
per to remark, that a greater degree of heat will compen- 
sate for a less quantity of corruptible materials, and the 
greater abundance of the latter, will make up for a less de- 
gree of the former : but where both abound in excess, there 
the epidemic will be liable to prevail with the greatest ma- 
lignancy. Consequently the bilious or yellow fever, as it is 
called, maj and does originate in any place where there is 
sufficient heat, moisture and corruptible materials, whether 

* Rush's Inq. and Obs. Vol. IV. p. 253. 



84 Origin, <y-c. of Endemic Fever. 

on the sea-board or in the interior of the country. Thus it 
has been known to prevail with as great fatality in the inte- 
rior of the srates of New- York, Pennsylvania, Ohio, and all 
the southern states, as in any of the large sea ports of the 
United States. The difference is, that wherever the bilious 
yellow fever makes its appearance in any populous city, 
particularly of the northern states, where the disease is 
more rare and terrific, the deaths which take place produce 
an alarm among the panic-struck inhabitants, disproportion- 
ate to the real cause and grounds of apprehension. At Sa- 
lina, in the interior of the state of New- York, the bilious 
yellow fever prevailed in the summer of 1822, with greater 
mortality than in the city itself, where it had produced the 
most alarming consternation, and where the affrighted pop- 
ulace were flying with precipitation from the presence of 
this terrific epidemic. Whilst, at the same time, at Ballston 
and Saratoga they were totally exempt from this disease, 
notwithstanding their want of quarantine laws, and the great 
numbers that were constantly thronging to those fashionable 
places of resort from the city of New- York, the very seat of 
infection. How will the advocates of imported and export- 
ed contagion account for all this ? Must they again he driven 
to their far-fetched hypothesis of fermentation ? One part 
of their explanation is involved in so many difficulties, that 
it may fairly be set aside on their own grounds. And as 
for the yellow fever making its appearance in the interior 
of a country, without the aid of importation, though it should 
be attended with every symptom of this fatal disease, yet as 
it cannot be traced to a foreign origin, they consequently 
will not admit it to be the yellow fever. The prevalence 
of the yellow fever at Salina without the aid of importation, 
and the exemption of Ballston, notwithstanding the free 
communication with the infected city, is to be accounted for, 
from the physical condition of the two places. Salina, the 
place of the salt works, being a low, flat, wet situation, 
abounding in ponds and stagnating water ; from which evils 
Ballston and Saratoga are in a great measure free. 

In proof of the importation of the yellow fever, it has 
been said that it is confined to sea ports ; whereas, it is well 
known, as already stated, that this disease has frequently 
appeared in inland situations, where its introduction from 
abroad could not possibly be suspected ; having, at various 
times and places, prevailed in the interior of the states of 
New York, Pennsylvania, Ohio, Virginia, North and South 
Carolina, Georgia, Alabama, &c. in none of which was its 



Origin, fyti^cf Endemic Fever, 85 

introduction from a foreign port ever suspected by the in- 
habitants.* 

If it be contended that the yellow fever is the natural en- 
demic of the West Indies, and thence introduced into the 
United States,, I would ask what circumstances necessary 
for its production in the West Indies do not abundantly ex- 
ist in various parts of our own country? The heat of the 
southern parts of the United States is equal, during the sum- 
mer season, to that of the tropics. The degree of tempera- 
ture in the northern states is seldom sufficiently intense and 
long continued to occasion its production, consequently it is 
there a less frequent disease. 

Dr. Pinkard, speaking of the yellow fever, says, " To look 
for it in ships and vessels, or to strain the eye across the 
ocean, in order to fix its birth place on the opposite coast of 
the Atlantic, or to trace its descent from the shores of the 
Indian seas, were to overlook the reality in search of a 
phantom. It needs no foreign parent; the prolific earth is 
its mother* its faiher the bright god who governs the day." 

If the yellow fever is an imported disease, why was it 
never introduced into Philadelphia during the interval from 
176 c 2 till 1773 ? At the time here alluded to, there were no 
quarantine regulations to serve as guardians to the public 
health; and a regular, extensive and uninterrupted inter- 
course was maintained with the West India islands. " The 
appearance of the yellow fever," says Dr. Ed. Miller, "in 
many of the interior parts of the country inaccessible to 
foreign contagion, confirms the opinion of its domestic ori- 
gin, while it entirely invalidates that of its importation. — - 
There is not a state in the Union, which has not offered ev- 
idence of the production of this disease, in situations where 
importation was impracticable. In the course of the season 
of 1805, a malignant fever, in all essential points the same 
as our yellow fever, prevailed in many parts of this state, 
(New- York.) and occasioned more mortality, in proportion 
to the population of the district, than took place in this city. 
There can be no reasonable doubt, that the disease called 

* For facts relative to this subject, I refer the reader to the following au^ 
thorities : EIiicott 1 s Voyage down the Ohio. Dr. Watkins' communication 
in the Medical Repository, Vol. IV. p. 75. Account of the Black Vomit 
and Dysentery in Mifiiin county, Penn. Ibid, p. 105. Dr. Blond's Obser- 
vations on the Yellow Fever of the valley of Patia, in South America. Ibid, 
Vol. VIII. p. 75. The Rev. Mr. Black's Account ot the Yellow Fever of 
Bethlehem, Con. in 1750. Ibid, Vol. II. p 88. Dr. Scott on the Yellow 
Fever of Gennessee Co. N. Y. Ibid, Vol. X. p. 248. Some of which have 
been already partially quoted in a preceding part of this treatise. 



86 Origin, fyc. of ErJejnic Fever, 

the lake fever, in the interior of this state, possesses all the 
essential attributes of the yellow fever."* 

Can we suppose that nature is so uncertain and changea- 
ble in her operations, as not to produce analogous effects 
from similarity of causes? Is it more difficult and unphilo- 
sophical to suppose the domestic generation of a pestilen- 
tial disorder, than that an epidemic should be imported from 
a foreign country, where disease under a different character 
existed ? Plants and animals may be exported and propa- 
gated in a land foreign to their parental country ; but disease 
is every where connected with physical causes and with the 
frail constitution of the human frame. The very elements 
are in a constant state of conspiracy against man's health and 
existence ; and the same sun that warms and cherishes the 
seasons, and restores renovated verdure and beauty to the 
vegetable world, dispenses with the boon of plenty the pes- 
tilential principles of disease and death. Trace nature in 
her work of destruction from Bengal to Batavia, from Bata- 
via to Africa, from Africa to Syria, from Syria to Constanti- 
nople, thence to Egypt, the West Indies, and to the United 
States, and in every country we shall rind nature working 
fey the same laws and modes of operation, the same agents 
and principles of disease, and a similarity of disorders. — 
Shades of difference in the diseases, like the varieties in 
the human figure and complexion, are observable in each. 
But as human nature, though disguised under the uncomely 
exterior of a negro, is human nature still, so endemic fevers, 
however diversified in appearance, are yet allied in every 
essential circumstance. 

The plague has prevailed at various times in different 
parts of Europe, Asia and Africa, from the 29th to the 56th 
degree of north latitude. By the term plague, I merely al- 
lude to diseases which have gone under that denomination, 
and not to any specific disorder invariably marked by the 
same set of symptoms : and by this appellation I under- 
stand an epidemic fever of a highly malignant and fatal 
character. Diseases vary in their features according to di- 
versity of seasons and situations; and the presumption is, 
that in what is called the plague, there is as great a variety 
of symptoms, as there is between the endemic bilious fevers 
of the United States and those of the East Indies. It has 
been formerly remarked, that a greater quantity of corrupt- 
ible materials will compensate for a less degree of heat, and 
that the excess of the latter will make up for the compara- 

* Report on Yellow Fever. Life of Miller, p. 1 18. 



Origin, &c. of Endemic Fever, 37 

tive deficiency of the former. We are hence enabled to 
explain how diseases, strictly the offspring of hot climates, 
may sometimes spring up in more northerly latitudes. la 
this way, we may account for the prevalence of pestilential 
fevers in London, during the fifteenth century, though situa- 
ted in the 51st degree of north latitude , in Marseilles, in the 
43d degree; and in Moscow, in 1771, in the 55th degree. 
These diseases, though like the yellow fever, more common 
to the south of Europe and the north of Africa, yet, under 
favorable circumstances, set geographical limits at defiance. 

According to the account of Sir James M'Gregor, in his 
Medical Sketches of the Expedition to Egypt, the plague is 
subject to as great a diversity of symptoms as the bilious fe- 
ver; depending on variety of season, situation, and other 
circumstances. When the disease first appeared in the In- 
dian army, the cases sent from the crowded hospitals, were, 
from the commencement, attended with low typhoid symp- 
toms. The cases of this disease which occurred when the 
army was encamped near the marshy ground of El Hamed, 
were all of the intermittent and remittent type ; those which 
took place in the cold rainy months of December and Janu- 
ary were of an inflammatory character ; and towards the 
end of the season, at Cairo, Ghiza, Boulac, and on crossing 
the isthmus of Suez, the disease appeared under the aspect 
of a mild continued fever. 

" You would be astonished, " says Lady Montague, " to 
find that the plague is nothing but a fever." And Dr. Rus- 
sell, in his account of the plague of Aleppo, says u it com- 
menced in the suburbs in the form of a remitting fever." 

u Why should it surprise us," says Dr. Rush, "to see the 
yellow fever generated amongst us ? It is only a higher grade 
of a fever which prevails every year in our city, from veget- 
able putrefaction."* 

The scientific and judicious Dr. Ed. Miller, in a letter to 
Dr. Rush, dated Dover, November 5th, 1793, observes, that 
" from the uncommon protraction and intenseness of our 
summer and autumnal heats, but particularly from the unu- 
sual drought, we have had, since the middle of July, a near 
approach to the tropical season, and that of consequence, 
we ought not to be surprised if tropical diseases, even of the 
most malignant nature, are engendered among us." In 
enumerating the symptoms of this disease, he remarks, that 
" bile discharged in uncommon quantities constantly assumes 
the most corrupted and acrimonious appearances, common- 

* Rush'.? Inq. and Obs. Vol. III. p. && 



88 Origin, &c. of Endemic Fever, 

]y eruginous in a very high degree? and sometimes quite 
atrabilious."* 

When the materials of disease are diffused and intimately 
blended with every portion of the air that is received into 
the lungs by respiration, it is vain and nugatory in the ex- 
treme to search for the general calamity in individual sour- 
ces of contagion. Where all breathe the same impure and 
infected atmosphere, all are liable to the prevailing disease, 
no matter whether they remain secluded in their houses, 
inhale the open atmosphere, or are exposed in their attend- 
ance upon the sick and the dying. Admitting that the air 
of the apartment of a patient laboring under yellow fever 
may be more corrupted and impure than the external at- 
mosphere, we know that all contagions by dilution and dif- 
fusion lose their virulence, so as to be incapable of produ- 
cing disease at a short distance from the patient's body.—. 
This law applies even to the small pox, the most contagious 
of all diseases. Dr. Haygarth, though an advocate for im- 
ported contagion, is yet satisfied, from observation, as to the 
limited sphere of its operation. "1 have proved," says he, 
" by facts, that the sphere of variolus infection, in moderate 
cases does not extend in the open air to the distance of half 
a yard, and in the worst, but a few yards from the poison. f 
The same rule, he thinks, applies to the American pesti- 
1 nee, or yellow fever.t 

We are informed by Dr. O. Ryan, that he placed a per^ 
son in the eruptive fever of the small pox by inoculation at 
about half a yard from four children properly prepared ; 
each exposure continued an hour, and was repeated daily 
for a fortnight, till the pustules had become perfectly dry, 
and that not one of the four received the infection. J An 
instance equally striking is mentioned by Dr. Odier. "At 
Geneva," says he, "we have frequently inoculated a great 
number of children during the years when the small pox was 
not epidemical. These children went about every day even 
after the eruption had appeared. They were sent into the 
streets, and the public walks, and have communicated free- 
ly with children, who were susceptible of infection ; yet the 
small pox did not spread by this intercourse. There even 
did not come to my knowledge an instance clearly proved 
of the infection being communicated to a single individual, 
either in the streets or public walks." 

* Rush's Inq. and Obs. Vol. Ill p. 208. 

t Haygarth on Small Pox, p. 161. 

£ Dissert, sur les Fievres Infect, et Contagieuse. 



Origin, fyc of Endemic Fever. 69 

Br. Rush was of opinion that the vapors from marshes 

might extend to the distance of two or three miles; others 
are equally liberal in their calculations. Such conclusions, 
however, seem to have been adopted without sufficient in- 
vestigation of the subject. To whatever distance noxious 
vapors may extend, it is not probable that they are in gen- 
era! capable of producing disease at a greater distance than 
two or three hundred yards from their source, and the pro- 
bability is, that they fail in their effect short of this calcula- 
tion. When the epidemic prevails over a large extent of 
country, it must be evident that no certain conclusions can 
be formed upon the subject. For although there may be 
insulated spots, which in themselves might prove healthy, 
on account of their physical exemption from the local causes 
of disease, yet being surrounded with an impure atmos- 
phere on evei-y side, highly charged with miasmata, every 
wind which blows must dissipate the poison, and waft it to 
a distance more or less remote from the place of its gen- 
eration. It has been remarked, however, that dilution de- 
stroys the infectious and morbific quality of noxious miasms, 
and as they must become more and more diluted by diffu- 
sion, and proportionally weakened by mixing with the gen- 
eral atmosphere, they must consequently soon lose their 
noxious and infectious properties. We are informed by 
Dr. Blane, that when the ships, in watering at a place call- 
ed Rock Fort, anchored close to the shore, so as to smell 
the land air, the health of the men was affected; but that 
upon removing two cables length no inconvenience was 
perceived.* 

We are told by Lancissi, that at Rome the south-east 
wind, termed by the Italians sirocco, which passes over the 
adjacent marshes, is most unsalutary ; and yet the effects of 
this wind have been experienced to extend only to those 
parts of the city which he nearest to the marshes, occa- 
sioning there an epidemic fever, whilst the rest of the city 
remained free from infection.. 

Onseveral occasions, when the fever, or plague, as it was 
called, raged in Rome, it was confined to the low grounds 
along the margin of the Tiber, leaving the drier and more 
elevated parts of the city unaffected; and it was a matter 
of astonishment to Baglivi, the medical historian of the 
limes, that so short a distance should make such a differ- 
ence in the qualities of the air. 

* Blane on the Diseases of Seamen, p. 229. 
M 



90 Origin, fyc. of Endemic Fever. 

It is observed by Dr. Lind, that when the British squad- 
ron, in the months of July and August, 1744, lay off the' 
mouth of the Tiber, one or two of the ships which lay near- 
est to the shore began to be affected by the pernicious efflu- 
via from the land; whilst the others lying further out at 
sea, at but a very small distance from the former, were en- 
tirely exempt from disease.* Dr. Lind thinks, that in the 
open air the sphere of infection does not extend beyond 
fifty or sixty feet from its source. 

We are informed by Dr. Rush, that the yellow fever has 
never been known to pass from Philadelphia to the Jersey 
shore; and the miasmata generated on the east side of the 
Schuylkill rarely infect the inhabitants on the opposite side 
of the liver.j 

Desgenette says the infection of the plague never crosses 
the Nile, and that its progress is arrested by means of 
ditches, dug and tilled with water for the purpose. 

It was remarked by Dr. Whitman, that the plague never 
passes the Dardanelles at Constantinople, from Turkey to 
Europe. 

Many persons escaped the plague which prevailed in 
London in 1665, by flying to the ships which lay in the mid- 
dle of the Thames. And we are told by Dr. Rush, that no 
instances of yellow fever occurred in those families in Phi- 
ladelphia that confined themselves to ships in the middle of 
the Delaware in the year 1793. 

As to the extent of contagion, it is remarked by Dr. 
Walker, that the contagion of small pox. measles, jail fever, 
and even of the plague itself, being emitted from a body or 
from fomites, in which the infectious particles are lodged, 
daily observation shows, that contact, or a very near ap- 
proach to the source of infection, is absolutely necessary to 
propagate the disease. t 

" If one speaks of an infected person," says Howard, 
"shut up in an unventilated chamber, it may be said that 
the whole atmosphere is dangerous ; but if one speaks of 
a patient exposed to the open air, it has been proved that 
the sphere of infection does not extend above five geom- 
etrical paces from his body. Beyond this distance, one is 
in safety. "§ 

" The sphere or origin of contagion," says Dr. Jackson^ 
" appears to be very confined ; a general epidemic disease 

* Lind on the Diseases of Seamen, p. 66. 
■f Inquiries and Observations. 

$ Walker on Small Pox, p. 481. 

* Howard's Account of Lazarettos, p. 34. 



Origin, $*c. of Endemic Fever* 91 

cannot easily be supposed to result from it; a direct com- 
munication, or near approach to the source being necessa- 
ry." The same author, in his remarks on the medical de- 
partment of the army, observes, that in the West Indies, 
"the dread of imported contagion is a bugbear; the fact 
{opinion) of importation in the manner alleged, is not sup- 
ported by one authentic history, and it is not consistent with 
the nature of things." 

Even Dr. Chisholm, one of the most strenuous advocates 
of contagion, admits that a person may safely enter the cham- 
ber of the sick, provided he avoids coming in contact with 
the patient or bedding; and thinks that the infectious efflu- 
via at most do not extend to a distance of more than six or 
ten feet.* 

If such is the difficulty with which malignant and infec- 
tious diseases are propagated by contagion, how are we to 
account for the prevalence of epidemics? Surely not upon 
the principle of contagion. How are we to account for the 
simultaneous appearance of the small pox, in different parts 
of the same town or district, and in persons who have never 
approached or seen a patient laboring under the disease ? 
How are we to account for its sudden appearance and its as 
sudden decline, unless by referring it to a general cause ex- 
isting in the atmosphere, requiring not the precarious and 
equivocal intervention and aid of a diseased person and hu- 
man contagion for its propagation ? And how vain is the idea 
of exterminating this disease, when the causes of its origin 
are unknown ? But there are other diseases with the origin 
of which we are better acquainted, and whose rise and prog- 
ress are evidently connected with physical causes, which it 
is in our power to prevent or avoid. Such are the intermit- 
ting and remitting fevers, the yellow fever and the plague. 
But Dr. Chisholm, as sanguine, and more unreasonable in 
his conjectures with regard to yellow fever, than Dr. Hay- 
garth is in relation to the small pox, cherishes the chimerical 
idea, that by the aid of quarantine regulations, the yellow 
fever will be completely exterminated, t In contradiction 
to this opinion I would observe, as a melancholy fact, that 
since the adoption of the system of quarantine in the United 
States, the yellow fever has been far more frequent, even in 
the sea-ports and cities where these regulations have been 
rigidly enforced, than it was previous to their adoption. 

* Essay on the Malignant Pestilential Fever, p. 135. 
t See his letter to Haygarth, p, 246. 



§2 Origin, fyc. of Endemic Fever, 

I am not disposed to make the unqualified assertion, that 
the plague and yellow fever are absolutely never conta- 
gious, under all circumstances ; analogy leads us to suppose 
that they may sometimes be communicated in this manner; 
and besides, if we may believe the reports of the contagion- 
ists themselves, tbere are well authenticated instances of 
sporadic cases having originated in this way : and though 
such an effect should not happen more than once in rive 
hundred instances of exposure, yet the chcumstance of its 
having once taken place removes the doubt as to the possi- 
bility of such an occurrence. It is obvious, however, that" 
the contagious nature of a disease can never be determined 
in the impure and corrupted atmosphere to which all are 
equally exposed. When each individual is enveloped in 
the common miasms of disease which fill the atmosphere of 
the infected town or settlement, it is altogether gratuitous 
and absurd to say, that such a person caught the complaint 
from visiting or attending the sick. The power of conx- 
municating the disease can only be determined by removing 
the patient to a healthy atmosphere ; if in this situation per- 
sons take the disease from visiting or attending the in- 
fected, the disorder may then be pronounced to be conta- 
gious ; but if no such communication of disease takes place, 
we are bound, by every principle of reason and common 
sense, to pronounce the disease absolutely uncontagious. — 
The latter has been the general experience in bilious or yel- 
low fever; of which there are but very few unequivocal ca- 
ses on record of its ever having been communicated in a 
pure atmosphere : and even the few that are recorded rest 
upon the partial testimony of the prejudiced and avowed 
advocates of contagion. But even admitting that on some 
rare occasions a person has caught the disease from coming 
in contact with the sick, receiving his breath, or by wearing, 
handling, or washing the clothes of a person who has died 
of the yellow fever, or by vapor from a bale of cotton, old 
clothes, or other substances, such instances go but a little 
way in the production of an epidemic. 

Upon this subject the ancients had more rational ideas 
than many of the moderns. Hippocrates, the father of phy- 
sic, and Sydenham the leader of medical improvement in 
Europe, have explained the general prevalence and diffu- 
sion of epidemics by attributing them to a certain noxious 
constitution of the atmosphere. Since the days of Syden- 
ham a similar opinion has been adopted by many of the 
most eminent physicians, who have written on the subject, 
ajnong whom we may mention, Boerhaave, Van Swieten. 



Origin, &c» of Endemic Fever. $3 

Mead. Hoffman, Ramazzani, Haxham and De Haen. In 
what this constitution or quality of the atmosphere consists, 
they do not pretend to inform us; though Sydenham sup- 
poses it to be an exhalation from the bowels of the earth. 
After a revolution of so many years it is carious to see this 
opinion revived in our own country by Mr. Webster. From 
the observations that have been already made, and from 
what remains to be advanced upon the subject, we shall, I 
think, be able to account for the origin of the diseases under 
consideration upon more rational and satisfactory grounds, 
and to establish the fact of their causes as arising from sour- 
ces less mysterious and occult than the bowels of the earth. 
Such an origin, however, suited the hypothesis of Mr. now 
-Dr. Webster ; who has endeavoured to prove that epidemics 
are connected as causes and effects, with the appearance of 
comets, the eruption of volcanoes, and the convulsions of 
earthquakes ; that pestilence is disseminated from the fiery 
tail of a passing meteor, and that yellow fever, small pox, 
&c. are vomited forthwith the fire and brimstone of Etna 
and Vesuvius. 

Though pl.igue was formerly supposed to be a specific 
disease, originating, in every instance, from morbid poison 
perpetually existing, yet this, like the yellow and other fe- 
vers which derive their source from animal and vegetable 
decomposition, has been ascertained by the experience 
and observation of numerous physicians to arise from local 
causes. 

\V T hether the other species, varieties, or forms of fever, 
such, for instance, as are not so evidently connected with 
obvious causes, as the spotted and malignant fevers which 
h-we of late years made their appearance during the winter 
and spring, in different parts of the United States, as also 
the small pox, measles, influenza, &c. whether these derive 
their origin from different modifications of the same causes, 
is a question which does not come within the scope of my 
present inquiry, nor does it admit of being so easily deter- 
mined. But the query may be suggested whether these dis- 
orders may not arise from morbific miasmata, the result of 
animal and vegetable decomposition existing in the atmos- 
phere, and variously modified by the season of '.he year, 
and the state of the weather, as it respects heat and cold, 
humidity and dryness ? Or may not the spotted or winter 
fever arise from some change in the elementary part of the 
atmosphere itself? As a diminution of oxygen and a dis- 
proportionate increase of nitrogen, from the consumption 
of the former, affected by the processes of respiration and 



\f4 Origin, <&c. of Endemic Fever. 

combustion, the latter of which is very considerable during 
the winter season, and which by withdrawing the vital por- 
tion of the air occasions a disoxigenation of the blood, and by 
this abstraction of stimulus, producing direct debility in 
the system, or causes the formation of a tcrtnim quid with 
a portion of the fluids destructive to animal life. 

From the evident connexion which is frequently observed 
to exist between epidemics characterized by diversity of 
symptoms, we are led to suspect an affinity and analogy in 
the causes which produce them. Such a connexion has 
long been observed; and whilst it enahles us to trace the 
simple operation of nature in bringing about the complicat- 
ed appearances of effects, it serves to break down the wall 
of partition which separated them by the unnatural and ar- 
bitrary laws of human compulsion. Judging only from the 
most striking and remarkable features, without considering 
the less visible but more immediate and important clue of 
connexion, physicians have been led to infer that a diversi- 
ty of symptoms was sufficient to establish a radical differ- 
ence in epidemical diseases. Though in natural history the 
animal kingdom may be classed according io the external 
resembljnce of the individuals which compose it ; yet in the 
pathological arrangement of diseases, the rules and princi- 
ples of art must yield to the less obvious, though no less cer- 
tain laws and principles of nature : here the classification 
should be made, not upon the capricious concurrence of a 
similarity of symptoms, which are perpetually changing, 
but upon a knowledge of the proximate cause. Until this 
is ascertained, the classification of diseases must continue 
arbilary and defective. 

The most common precursors of the more malignant epi- 
demics are measles, catarrh, influenza, angina, and hoop- 
ing-cough, which are also apt to appear upon the decline of 
the more malignant disease. Nor does an epidemic often 
arise without a progressive order and increasing malignan- 
cy in the diseases which have preceded it. This precurso- 
ry epidemic is of longer or shorter duration according to 
circumstances : and it appears from the London bills of 
mortality that malignant diseases were generally increased 
in number and violence during the spring months which pre- 
ceded the plague in 1625, 1630, and 1665. The same thing 
has been remarked in many instances, where the yellow fe- 
ver has prevailed in different parts of the United States. — - 
The bilious yellow fever of Philadelphia in 1793, according 
to the account of Dr. Rush, was preceded by the influenza 
and the milder forms of bilious fever. The same disease ia 



Origin, ire. of Endemic Fever. 95 

] 794 was preceded by obstinate intermittents. " From the 
inflammatory complexion of the diseases of the spring, and 
of the beginning of June," says Dr. Rush, " I expected the 
fevers of summer and autumn would be of a violent malig- 
riant nature. I was the more disposed to entertain this opin- 
ion from observing the stagnating filth of the gutters of our 
city; for the citizens of Philadelphia having an interest in 
rejecting the proofs o( the generation of the epidemic of 
1793 iri their city, had neglected to introduce the regula- 
tions which were necessary to prevent the production of a 
similar fever from domestic putrefaction."* The same ob- 
servation was made by Dr. Caldwell. f We are informed 
by Dr. Bailey, that the epidemic which prevailed in New- 
York in 1796, was preceded by angina trachealis, attended 
with anomalous symptoms, cases of obstinate dysentery, and 
by febrile disorders accompanied with bilious evacuations. 
Early in July, these facts were noticed at a meeting of the 
medical society ; and the society, from the conviction of 
something uncommon in the state of the atmosphere, came 
to the resolution of making particular observation on the 
nature of the diseases which might occur previous to their 
next meeting, but in the mean time the growing disorder 
declared itself in the unequivocal character of a prevailing 
epidemic. 

Most persons, and especially physicians of observation, 
have, remarked, that when bilious or yellow fever of an in- 
flammatory character has prevailed in summer, the fevers 
which succeed in the winter partake of the same character, 
are attended with bilious discharges, yellow skin, &c, but 
are distinguished by this remarkable peculiarity, that the in- 
flammatory symptoms are of short continuance, being sud- 
denly succeeded by typhus. From their rapid disposition 
to assume the typhoid character they are often more fatal 
than the diseases of summer, and without impropriety may 
be called the pestilence of winter, sometimes denoting an 
epidemic of the succeding summer* The same aggravation 
of disease from the cold of winter has been observed of the 
small pox. It was remarked by Sydenham, that in those 
years in which the small pox was epidemic and mild, it usu- 
ally began about the vernal equinox ; but when it was epi- 
demic and of a dangerous kind, it usually began in the 
month of January, seising whole families, and sparing none 



* Rush Inqu. & Obs. vo. 3, p. 358. 

t Appendix U Albert on Malig. Intermit. p. 4& 



96 Origin, fyc. of Endemic Fever* 

of whatever age or sex they might be. unless they bad pre- 
viously passed through the disease.* 

Lord Bacon, who lived at a period when the plague was 
frequently epidemic in England, observes, " the lesser infec- 
tions of the small pox, purple (ever, agues, &e. in the pre- 
ceding summer, and hovering all the winter, portend a great 
pestilence of the following summer, for putrefaction rises 
not to its height at once."t 

We may remark this connexion of malignant diseases 
with the universal plague, which prevailed successively in 
1635, 1636, and J 637. The progress of these diseases is 
distinctly traced by Diemerbroeck. He remarks, Chapter 
de Peste, that u the spring of 1653 was warm and mode- 
rately humid ; to which succeeded a very hot dry season, in 
which appeared many malignant epidemics. In the first pl,ce 
a severe plague broke out at Leyden, by which more than 
20,000 persons were destroyed. At r\im-guen, in Guil- 
ders, and other regions, a certain pestilential fever spread 
with dreadful mortality. In autumn, severe heat still con- 
tinuing, with excessive drought, many other malignant dis- 
eases appeared,, as small pox, measles, diarrhoea, and dysen- 
tery of a very bad type: but more especially the above 
mentioned purple fever, called in Italy petechial, increased 
in extent and violence, until it had turned into the true 
plague. | He further remarks, that from November, through 
the winter, scattering cases of plague occurred at Nime- 
guen : that in January, 1636, it increased, and in March 
spread and became epidemic ; rose to its height in April, 
and continued till October. 

The circumstance of spotted fever gradually assuming 
the character of plague, until at length it became converted 
into the plague itself, seems to be fundamentally opposed 
to the doctrine of specific contagion, as essentially necessa- 
ry for the propagation of this disease : and contradicts the 
opinion of Doctors Mead, Cullcn, and others, who contend 
for its specific nature. § " The fact," says Dr, Webster, " is 

* Swan's Sydenham, p. 96. 

t Raoon's Works, vo. Ill p. 59. 

| Donee tandem in apertissimam pest°m transient. 

} 1 here make my acknowledgments to Mr. Webster, for directing my 
attention to some useful and interesting references It may be proper to 
inform those who are unacquainted with the circumstance that \ r. now 
Dr. Noah Webster has written a work in two volumes octavo, for the pur- 
pose of proving that epidemics owe their origin to the appearance of comets, 
the convulsions of earthquakes, and the eruptions of volcanoes. Though 
there is much visionary speculation in this performance, the reader is, jn 
some decree compensated for his trouble, by the many interesting facte 
which the learned author has recorded. 



Origin, fyc. of Endemic Fever, 97 

undisputed. In the distressing period from 1569 to 1677, 
when. Europe was almost depopulated by the spotted fever, 
physicians observed that the disease frequently ran into the 
plague and the plague into the spotted [ever. The same fact 
was often noticed by authors of the 16th and 17th centuries, 
in which the piague frequently overran Europe. These 
two diseases are, therefore, two distinct forms or modifica- 
tions of pestilence, probably bearing an affinity to each 
other, like that between the distinct and confluent small 
p-o^." " This fact," says tiie s une author, " shows that the 
distinction made by medical writers, between pestis andjoes- 
tlleniia. the plague and pestilential distempers, however 
useful in practice, is not authorized by truth and philoso- 
phy. The ancients classed all contagious epidemics togeth- 
er, and denominated them pestilence, and this distribution, 
in regard to their causes and origin was doubtless most phi- 
losophical.''* 

The same connexion is noticed by Reverius in his Praxi- 
os Mriiendi, lib. 1 7. 4> Many deadly diseases," says he, " ac- 
company the prevalence of pestilence; as phrenitis, angi- 
nas, pleurisies, pcripneumonies, inflammations of the liver, 
dysenteries and many others." And Bottinus, after des- 
cribing the circumstances connected witfi the origin of the 
plague, as impure air, bad food, intemperate seasons, &c, 
gays its invasion was preceded by epidemic diseases, such as 
petechial fevers, small pox, measles, dysentery and epidem- 
ic pleurisy.! The universal prevalence of malignant dis- 
tempers, which immediately preceded the plague of 1565, 
was noticed by Sydenham with his usual accuracy. " J nev- 
er knew," says he, " pleurisies, quinsies, and other inflam- 
matory diseases, more common than they were some weeks 
preceding the plague in London in 1665." Those inflam- 
matory diseases which prevailed in the winter and spring, 
yielded as the season advanced and the weather became 
milder to a malignant fever, which appeared as the imme- 
diate precursor of the plague; into which it changed by 
such insensible degrees that Sydenham himself was at a loss 
to determine whether that fever was the plague or not; and 
what appears as a convincing argument of their being but 
different degrees of the same disease, is the circumstance 
noticed by Sydenham, that when the plague in autumn be- 
gan to abate, the same malignant (over reappeared.!-— 

* Webster on Epidemics, vo. 2, p. G?, 

t De Febribu?, p. 265. 

t Sydenham, 'vo. I. p. 122, 130. 

N 



93 Origin, ire. of Endemic Fever, 

Which is but saying that as the season progressed, the dis- 
ease lost by degrees its pestilential character of glandular 
swellings, and became less malignant. The same facts are 
noticed by Hodges and Morton. In 1719, the year before 
the great plague in Marseilles, a pestilential fever broke 
out in the city, which, in some cases, was attended with bu- 
boes and carbuncles. From which it appears that the plague 
actually began six months previous to the pretended intro- 
duction of infection from Syria. We are informed by Dr. 
Russel, that the plague which appeared in Aleppo, in 1 742, 
was preceded by an acute fever ; and after the disease abat- 
ed in July, diarrhoeas and dysenteries of malignant type, at- 
tended in many cases with petechias, made their appear- 
ance ; as likewise intermittents, which often proved fata!*, — 
These diseases, in their acute forms, prevailed also with the 
plague, which at this season was less malignant than usual, 
nor did it predominate to the entire exclusion of other dis- 
eases. The dreadful plague which prevailed at Messina in 
1743, and which destroyed two thirds of its inhabitants, was 
immediately preceded by a malignant fever. One physi- 
cian alone, out of thirty three, pronounced it the plague ; 
but the others denied it, because the disease was not at- 
tended with glandular swellings. A similar (ever preceded 
the severe plague at Venice in 1576, and the physicians 
and magistrates were at first embarrassed with the same un- 
certainty. The terrible pestilence which raged at Na- 
ples in 1656, was ushered in by its usual precursor, a ma- 
lignant fever ; one physician alone pronounced it the plague, 
and for his presumption, the Viceroy condemned him to 
imprisonment. The extensive pestilence which from 1759 
to 1763 spread its destructive ravages over all the countries 
and islands of the Levant, was every where preceded by a 
similar increase of malignant diseases ; and more especial- 
ly by the petechial fever which prevailed at Aleppo in the 
year preceding the appearance of the disease, under the full 
marked character of the plague. " Yet Patrick Russel, the 
author of this account," (says Mr. Webster, who refers to 
this circumstance, with his usual dryness,) labors very grave- 
ly to trace the disease to the Turks from Egypt, and their 
old clothes. The malignant disposition of diseases at certain 
times was noticed by Hippocrates. " There are times," 
says he, u when almost all the diseases which occur are ex- 
tremely malignant and as generally fatal.; so that coughs, 
pleurisies, anginas, are all equally fatal." He assures us that 
the truth of his observation has been confirmed in countries 
very remote from each other, and in a variety of seasons 



Origin, &c. of Endemic Fever* 9$ 

and climates. The plague of Aleppo in 1742, which first 
showed itself in the suburbs in April, was preceded in March 
by an acute fever. Schenkius says that the plague of 1574 
was preceded by malignant fevers. " In the same manner," 
says he, " small pox, measles and dysenteries are very often 
the precursory heralds of the plague." Those epidemic in- 
fluenzas and catarrhs which frequently prevail over exten- 
sive districts of country, we are often unable to trace to 
any change of temperature, or prevalence of dampness: — - 
They therefore seem to be connected with some secret 
cause in the atmosphere itself, independent of cold or hu- 
midity. Between these diseases and the measles there is 
an evident affinity, not only in their nature and symptoms, 
which require a similiarity of treatment in both, but like- 
wise in the cause or causes from which they originate; as 
satisfactorily appears from their preceding and following 
one another as epidemics. This circumstance, and the evi- 
dent connexion which exists between epidemics in general, 
are well illustrated by Dr. Webster. u In the year 1772," 
says he, " the catarrh and measles raged in the same year, 
from Boston to Charleston. To these succeeded anginas 
and dysenteries for a series of years. In 1781 and 1782, 
catarrh pervaded the globe. In 1733, began measles in 
May, and anginas in August. In 1 789, measles preceded the 
influenza. In 1757, influenza preceded the measles." The 
same author, speaking of the plague in Europe, says, " At 
the same time raged in America a series of epidemics, par- 
ticularly measles, anginas, and the bilious plague; the lat- 
ter appearing in Philadelphia and Virginia in 1741, and in 
New York in 1743, in the same year with the dreadful pes- 
tilence of Messina. The plague appeared in Philadelphia 
in 1762; and the fatal epidemic pleurisy in 1761."* 

Dr. Rush divides the patients affected with yellow fever 
in 1793 into three classes, according to the progressive ma- 
lignancy of the symptoms. In the third he includes all those 
in whom the miasmata acted so feebly as not to confine them 
to their beds or houses; of these he says some died, who 
conceived their complaints to be occasioned by a common 
cold, and neglected to take proper care of themselves, or 
to use the necessary means for their recovery.! The con- 
nexion of intermitting fever and scarlatina anginosa was ob- 
served by the same author in 1789. " The intermitting fe- 
ver," says he, " which made its appearance in August, wag 

* Webster on Epidemics, Vol. II. d. 10&. 
1 Inq. and Obs. Vol. Ill, p. 137. 



100 Origui, fyc. of Endemic Fever. 

not lost during the month of September. It continued to 
prevail, but with several peculiar symptoms ; in many per- 
sons it was accompanied with an eruption on the skin, and 
a swelling of the hands and feet. In some it was attended 
with sore throat, and pains behind the eats. Indeed, such 
was the prevalence of this contagion which preceded the. 
scarlatina anginosa, that many hundred peopie complained 
of sore throats without any other symptom of indisposition. 
The slightest exciting cause, and particularly cold, seldom 
failed of producing the disease.* 

The tendency which epidemics have to confound them- 
selves with each other by prevailing at the same time, was 
accurately noticed by Dr. Sydenham ; and the fact has since 
frequently been observed by others. Dr. Bard, speaking 
of the malignant pleurisy at Huntington in the year 1749, 
says the distemper was brought into the city when the erup- 
tive fever was epidemical ; and immediately the small pox 
was propagated by inoculation in a great, many different 
parts of the town, whilst the constitution of the air which 
favored the eruptive fever> was at its height. The conse- 
quence of which was, that so long as the symptoms of the 
small pox appeared from inoculation, the then prevailing con- 
stitution of the air changed its symptoms, in a great measure, 
to its own likeness; most of the characteristic symptoms of 
the preceding fever, accompanying those of the small pox: 
until by degrees the small pox, spreading over the city, ex- 
tinguished the eruptive constitution, and then existed in its 
own simple form ; after which inoculation was practised 
with its usual success.! 

A less degree of the same causes which give rise to the 
more aggravated forms, will produce the intermitting feVer*; 
and in the southern states it is not unusual to observe, in the 
progress of the season, the successive degrees of increasing 
malignancy, from the simple intermittent to the bilious or 
yellow fever with black vomit. 

Every accurate observer has remarked the striking con- 
nexion which exists between what is called yellow fever and 
the inferior gradations of endemics, down to the intermitting 
fever itself. Indeed, one of the most frequent terminations 
of the yellow fever of the southern states, is in the inter- 
mitting fever; which is often a more obstinate disease than 
the former: nor is it uncommon for the intermitting to 
change its character to that of the yellow fever. This I 

P Inq. & Obs. Vol. I. & Vol. III. p. 145. 

| American Medical and Philosophical Register, Vol I. p. 420. 



Origin fyc. of Endemic Fever- 161 

have frequently observed ; and in times of the general prev- 
alence of bilious fever, I have made it a point to stand upon 
my guard against such insidious and deceitful appearances; 
for if neglected, after one, two or three repetitions of the 
paroxysms of fever and ague, the disease is apt to become 
continued, and to assume the most malignant aspect. A 
disease, which at first would have yielded to venisection, 
an emetic, cathartic, or a few doses of Peruvian bark, by 
neglect, becomes converted into a case of malignant and 
fatal yellow fever. All these different grades of disease 
prevail at the same season ; and the fever appears under 
different characters and types, according to the constitution 
of the subject, the degree of predisposition, and the force of 
the exciting causes. 

Dr. M'Lean observes, that he has " often seen the inter- 
mittent commence the attack, and repeat its form for one or 
two paroxysms, and afterwards, as the cause gained strength, 
assume the remittent shape, and prove fatal." He further 
remarks, in another place, that after all the instances of the 
yeliow fever which he has witnessed, and all the attention 
he could pay to it. he is of opinion it is the common remit- 
tent of the West Indies, rendered formidable by being ap- 
plied to the English constitution ; that the variety which 
appears in its progress depends entirely on the variety of the 
several constitutions which it attacks; and that the yellow- 
ness which gives it a peculiar name, only marks its worst 
stages, and is rather an accidental than a peculiar charac- 
teristic* 

Dr. Robert Jackson, speaking of the diversity of aspects 
which is often assumed by the endemic fever of the West 
Indies, makes the following observations.! The cause of 
endemic fever, continued, remitting, or intermitting is one, 
but great variety is produced in the form and manner of ac- 
tion. The disease, in the more violent forms, is, or appears 
to be continued in some situations, in others, it is remitting 
and of regular type. In wet weather and on swampy grounds, 
the endemic of the country is usually remitting in form : and 
under this form, exhibits appearances of jaundiced yellow- 
ness, of black vomiting, purgings of black matter, haemor- 
rhage from different parts of the body, petechias, livid- 
ness, &c." 

* M'Lean's Inquiry into the Nature and Causes of the great Mortality 
among the Troops in St Domingo. Lond. 1797. p. 73 & 86. 
t Outline of the History and Cure of Fever, p, 202. 



102 Origin, fyc. of Endemic Fever, 

It is said that during the prevalence of the yellow fever 
in New- York, in 1 798, every grade of disease, from the mild- 
est febrile affection to the most malignant and pestilential 
was exhibited in the course of the epidemic. Except in a 
few instances, however, the number of mild cases greatly 
predominated over the malignant. Some assumed the char- 
acter of intermittents, and yielded to a very slight treatment ; 
more appeared under the form of remittents* without any 
symptom of malignity, and speedily yielded to the proper 
remedies. As a proof of the affinity and resemblance exist- 
ing between this epidemic and the plague, we are informed 
that cases of anthrax and buboes* were observed ; that one 
patient was affected, for twenty-four hours previous to his 
death, with spasms of the pharinx, neck, back, and arms; 
exhibiting the combined horrors of tetanus and hydropho- 
bia.* 

It is remarked by Dr. Caldwell, that the yellow fever of 
Philadelphia in 1805 was preceded by intermittent fever, 
diarrhoea, and dysentery.! 

It is remarked by Dr. John Hunter, that the fevers of the 
West Indies are similar to what are called the marsh and 
remittent fevers in Europe, only more malignant ; and arise 
from the same causes, viz. noxious exhalations from low, 
wet and marshy grounds.} 

It was observed by Dr. Rush, that the epidemic of Phila- 
delphia in 1802, assumed four principal grades, viz. the in- 
termittent, the mild remittent, the inflammatory bilious fe- 
ver, and the malignant yellow fever; all of which, in many 
Instances, ran into each other. 4i A tertian," says he, •• has 
ended in death, with the black vomiting ; and a fever with 
the face and eyes suffused with blood, has ended in a quo- 
tidian, which has yielded to a few doses of bark."§ In the 
further prosecution of the subject of the relation between 
the regular tertian, or the fever and ague, and the yellow 
fever, he remarks, " The bilious fever indicated its descent 
from this parent disease. I met with many cases of regular 
tertians, in which the patients were so well on the interme- 
diate days as to go abroad. The tertian type discovered 
itself in some people after the more violent symptoms of the 
fever had been subdued, and continued in them for several 
weeks." 



* Med Repos. Vol. II. p. 198-9. 

f Essay on the Yel. Fev. Appen to Alibert on Malig. Intermit, p. 4^» 

\ Hunter on the Diseases of the Army in Jamaica, p. 15. 

| See his letter ia the Med. Repos. Vol. VI. p. 169. 



Origin, fyc* of Endemic Fever. 103 

Cases of intermittent, remittent, and typhus fevers, were 
observed to prevail at the same time in the same family, by 
Dr. Trotter. The remote causes of those fevers appeared 
to be the same in all, viz. a cold, damp house, and deficien- 
cy of diet. The same thing was observed by Dr. Trotter 
in the navy and in the public hospitals. A similar observa- 
tion was made by Mr. Crawford, that on board of every ship, 
at the time the yellow fever was the most fatal, there were 
a number of cases of intermittents. Mr. Crawford was of 
the opinion that the cases of intermittents originated from 
the contagion of the patients laboring under the yellow fe- 
ver.* A more probable presumption is, that they all ori- 
ginated from a common cause, viz. heat, moisture and pu- 
trefaction. 

The (liiTerent quantities and degrees of heat, moisture, 
and corruptible materials, in different places, will occasion 
a corresponding diversity in the endemic of the same season. 
As the causes of disease in large cities generally exceed those 
of the adjacent country, we can easily account for the great- 
er severity and malignity of symptoms in the endemic of the 
former than that of the latter situation. This circumstance 
is ably represented by Dr. Edward Miller, in the following 
words : " As the materials of putrefaction and the degrees 
of heat, in a large city, greatly exceed what is found in the 
adjacent country, so the diseases arising under such circum- 
stances must be proportionably more malignant. The pes- 
tilential fevers of our city (New- York) differ only in grade 
from the bilious and remittent fevers of the country. They 
prevail in the same climates ; they come on at the same sea- 
son of the year; they are chiefly disposed to attack persons 
of the same constitution ; they commit their ravages on the 
same organs of the body, and produce symptoms differing 
only in degree ; and they decline and disappear at the same 
season and under the same circumstances. In the city we 
often see in the same family, and under equal circumstances 
of exposure, the malignant forms of pestilence and the mild 
forms of remittent fever ; and in the country, while the great 
mass of cases are generally mild, we occasionally meet with 
some which exhibit the violent attacks, the intense maligni- 
ty, and the rapid dissolution, which more frequently mark 
the pestilential fevers of the city.t" 

We are informed in Sir George Staunton's Account of the 
Embassy to China, that the malignant fevers of Batavia cod- 
ed in the tertian form. 

* Trotter's Med. Narr. Vol. I. p. 185, and Vol. II. p. 99. 
t Report on Yellow Fever. Life of Miller, p. 92. 



104 Origin, &c, of Endemic Fever, 

From the survey which has been taken of the nature, ori- 
gin and causes cf epidemic and endemic fevers, it will be 
seen that there is a genera] analogy, and a chain of connex- 
ion, observable in the whole, from the mildest form, or in- 
termitting fever, to the more aggravated grade, under the 
name and character of plague. What has been considered 
the most characteristic feature of this disease, viz. the ap- 
pearance of glandular swellings, buboes and carbuncles, takes 
place but in a small proportion of cases. Such affections 
have likewise been observed in the yellow fever-, so that 
from o\ery consideration we are led to conclude that the 
plague is nothing more than a high grade of endemic fever, 
marked with some peculiar symptoms of malignity; and 
like the yellow or bilious remittent fever, owing its origin 
entirely to local causes. 

It should be considered as a subject of regret that no 
name more appropriate and generally applicable than that 
of yellow fever, has been selected to designate the endemic 
of our country; since the yellowness of the skin is by no 
means an inseparable characteristic of the disease. In many 
malignant and fatal cases, as well as in those which termi- 
nate iu recovery, this symptom is never observed. Dr. 
Moseley, speaking of the endemic fever of the West Indies, 
remarks, that "yellowness of the skin, like black vomiting, 
is not an invariable symptom of this fever: those who arc 
fortunate enough to recover, seldom have it; and many die 
without its appearance." Besides, yellowness of the skin 
takes place in other diseases. An epidemic is mentioned 
by Haller, in which the body turned yellow.* We are in- 
formed by Lasonne, in the Medical Commentaries, that he 
sometimes observed it in a disease occasioned by putrid cat- 
tle : and Dr. Lind mentions its occurrence in several cases 
of typhus. There are instances of jaundice accompanying 
tits of the intermittent fever in England. And Dr. Hunter 
observes, that he has seen two examples of yellowness or 
jaundice in the hospital, or jail fever.t This symptom can 
only be considered as an indication of redundancy of bile in 
the primaeviss; which may, or may not, according to circum- 
stances, be absorbed and conveyed into the circulation in 
such quantity as to produce a yellow suffusion on the sur- 
face of the body. That the bile is absorbed and conveyed 
into the blood in yellow fever, there can be no doubt; and 
we are informed by Dr. Lind. that he found the serum of 

* Haller Opera. Monor. Vol. III. p. 374. 
t Hunter on the Diseases of Jamaica, p. 91. 



Origin, fy'c. of Endemic Fever. 1£)3 

the blood of a patient laboring under this disease to be bit- 
ter.* 4i I hare seen," says Dr. Monro, u the eyes, the 
skin, with the urine, as deeply tinged by the bile, in typhus, 
as I have remarked it in the yellow fever of the West In- 
die*."! 

The yellow, or bilious fever, is called by the French, La 
Maladie de Siam, from its being frequent in the kingdom of 
Siam, in the East Indies. They also call it, La Fievre Mat' 
tlottei or Sailor's Fever, on account of strangers and sea- 
faring people being most subject to it: and the Spaniards 
call it, Vomit o Preto, or the black vomit, from one of its dan- 
gerous and alarming symptoms. Hillary calls it the putrid 
bilious Jever ; by Chisholm it has been styled the malignant 
pestilential fever ; Mosely denominates it the endemial caw 
sus, identifying it with the febris ar den's of Hippocrates, Are- 
tus and others; by Tovvne it is termed febris ardens biliosa. 
To most of which appellations there are objections, inas- 
much as the disease is by no means invariably characterized 
and attended by all the symptoms, respectively, from which 
it has received its distinctive appellation. A name of more 
universal application than any other, is the bilious remitting 
fever. As a redundancy of bile is one of its most insepara- 
ble symptoms, a name expressive of this circumstance must, 
consequently, be considered more appropriate than any oth- 
er which is less constantly observed. It is true that a 
redundancy of bile is sometimes observed in other fevers, 
though so seldom as not to afford a material objection to the 
term bilious, as applied to the endemic fever of hot climates. 

But it is contended that there is a specific distinction be- 
tween the bilious remittent of hot climates and the yellow 
fever. To affirm and to prove, however, are very differ- 
ent ; and when one disease is so much like another in its 
causes, symptoms and cure, that no difference can be de- 
tected, we are bound, by the rules of common sense, to con- 
sider them as the same. It is admitted by the contagionists 
that in Mobile and New Orleans the yellow fever has pre- 
vailed : 1 have witnessed the diseases of both places, and I 
have also seen the endemic fever in various parts of the 
states of Alabama, Florida and Louisiana, and I can with 
truth affirm, that between the more aggravated forms of fe- 
ver in all these places, there is not a shade of difference. 

As a characteristic of the yellow fever, it has of late years 
been contended by some physicians, particularly by Dr. 

* Lind on Fever and Infection, p. 13. 

# Monro on the Diseases of the Army, p. 259. 

O 



106 Origin, fyc. of Endemic Fever* 

Pjm of England, that the disease attacks the human frame 
but once. If such were the fact, however, in relation to the 
yellow fever, it is strange that a circumstance so striking 
was never received as a principle in medicine previous to 
the time of Dr. Pym. In relation to the small pox, the 
knowledge of this fact is coeval with that of the disease; 
but from ancient^ modern, and universal experience, we are 
bound to reject the application of this law to the yellow fe- 
ver. The object of the abettors of this doctrine, is to es- 
tablish the specific nature of the yellow fever, as differing 
essentially from all other forms of simple fever. But in re- 
lation to the subject of contagion and the specific character 
of diseases, the opinion is nugatory and unavailing ; for what 
disease is more contagious and specific than the venereal? 
which is, at the same time, unlimited in the number and 
repetition of its attacks upon (he same individual. Truths 
which have long been established by observation and expe- 
rience, are never indebted to speculation and hypothesis 
for their authenticity ; but fictitious facts, created with a 
view of supporting a favorite opinion, like that of Dr. Pym, 
bear upon their front the stamp and evidence of their own 
inanity. 

In all parts of our country where the yellow fever has 
prevailed, its origin has been easily traced to local causes. 
The local origin of the yellow fever of New- York in 1795, 
is satisfactorily accounted for by Dr. Bailey. In his letter 
to the Rev. Richaid Canning Moore, he gives us the follow- 
ing information.* Such was the filth and accumulation of 
putrefying materials on the south side of Pearl street, be- 
tween Old Slip and White- Hall, that the poisonous exha* 
lations which abounded in that quarter, during the warm 
weather in the beginning of August, so changed the air, that 
the disagreeable effluvia frequently obliged the inhabitants, 
especially in the evening, to close the windows on the south 
side of their houses ; and, in several instance?, the offensive 
smell was such as to occasion vomiting in those who were 
exposed to the exhalations. The wharf on which Mr. Dela- 
field's stores were erected, we are told, was in a slate truly 
execrable, and the slips on the right and left were in a con- 
dition little better. " These, and such places," says Dr. 
Bailey, '* are visited by the dock fever— the yellow fever, it 
you please, that murderer of our own creating." These 
noxious and offensive effluvia, he informs us, were evolved 
from putrefying substances, among which were dead dogs, 

* Philad. Med. Mus. Vol. I. p. 50 k 51, 



Origin, #-c. of Endemic Feveri 101 

cats, horses, and other noxious matters, collected from the 
streets, and deposited for the purpose of filling up the unfin- 
ished docks. "New-York," continues the Doctor, "as I 
have said before may be rendered as healthy a city as any 
under the sun ; and when a more rigid police prevails, and 
the nuisances with which this city abounds are corrected, 
you will hear no more of the ravages of pestilential disea^ 
ses."* To this description of the local causes of the origin 
o( the yellow fever in New-York, as given by Dr. Bailey, 
may be added, that many of the streets in the lower part of 
the city were crooked, narrow, and dirty, and, at the time 
here alluded to, badly constructed ; without any regular 
drain for the water, which stagnated in holes and puddles 
in the. streets, and in the back yards of the houses, espe- 
cially where the streets had been raised, and the adjoining 
lots left upon their original level, forming, as it were, a 
sink or basin of putrid water and the corruptible refuse of 
the kitchens. 

Pr. Jameson, in his observations on yellow fever,? re* 
marks, that in all the epidemics he has seen in Baltimore, 
and which may be considered as caused by miasmata, all 
the circumstances considered essential in the production of 
bilious fever, were most obviously present; these were, 
made grounds in marshy situations ; foul wet cellars; hot 
dry weather, succeeding to wet springs productive of luxu- 
riant vegetation ; together with a number of days in which 
Fahrenheit's thermometer rose above 80 degrees. 

Dr. Rosset, in a letter to Dr. Miller, gives an account of 
a pestilential fever which prevailed at Wilmington, N. C, 
in 1796 ; which he considers as having originated from local 
causes, from the circumstance of the state of the weather, 
the effluvia of adjacent marshes, and its not being traceable 
to any foreign source. But, notwithstanding its malignan- 
cy, no instance could be discovered of its being communi- 
cated by contagion. " A few cases," says Dr. Rosset, "of 
our common fall fever, every year put on all the symptoms 
of a violent fever.!" 

It appears from the account of Baron Laray, that there 
is but a shade of difference between the yellow fever an<| 
the plague. The causes which produced the yellow fever 
among the wounded in Egypt, were the crowded state of 
the hospitals, the situation of the camp, on the west side of 
Cairo, being low and moist, more especially after the waters 

* Med. Repos. Vol. I. p. 119. 

t Medical Recorder, Vol. VI. p. 435. 

+ Med. Repos. Vol. II. p. 144. 



108 Origin, 4 f c* of Endemic Fever. 

of the Nile had receded from a place where they had un- 
dergone putrefaction from long exposure to the heat; the 
sudden transition from the scorching heat of the day, to the 
moisture of the night, to which the troops were exposed, 
tending to weaken the body, and to predispose to, and to 
excite the disease; and the heat and damp of the atmos- 
phere, in the season of the Kamsyn. '■ At this time, also,*' 
says Laray, " Jhe plague prevails, and we might say that the 
yellowfever, from the similarity of its effects, and its speedy 
termination, has some analogy to this scourge." 

The same remark has been made by the celebrated Dr. 
Humboldt, who has seen these two diseases, the plague in 
Turkey, Syria, and Africa, and the yellow fever in New 
Spain and Vera Cruz. u Indeed," says Laray, " if we com- 
pare the phenomena of the two diseases when they are acute, 
and attack persons of the same age, and of the same sex and 
temperament, we shall find in the first stage that the anxiety, 
the restlessness, and inquietude of the patient, the pains in 
the head, the loins, and hypochondria, the vomiting, the red- 
ness of the conjunctiva, the burning heat of the intestines, 
the dryness of the skin? the hardness and frequency of the 
pulse are, with some varieties, nearly the same in the plague 
and in the yellow fever. In the second stage, the prostra- 
tion, the accession of delirium, the total suspension of the 
animal functions, indicated by the dyspnoea, nausea, the sup- 
pression of the alvine evacuations, and afterwards involun- 
tary and colliquative discharges and irregularity of the pulse, 
are also symptoms common to these two diseases. In this 
stage, the one is distinguished by a yellow color, which ap- 
pears and extends over the whole surface of the body; the 
other by livid spots, petechia?, carbuncles, or buboes, which 
may likewise occur in the yellow fever, but much more 
gradually •> buboes and carbuncles seldom occur, but pete- 
chias frequently in the third stage of the disease.-'* 

From all which, and from what Assalini has said upon the 
same subject, we may gather that what is called the plague 
in Egypt is nothing but the common endemic fever of the 
country, liable at certain times, as in other places, to slight 
changes of features. Assalini describes the endemic fever 
of Egypt as one disease, and makes no distinction into yel- 
low fever and plague, a distinction in all probability with- 
out a difference. With the same propriety, the physicians 
of our country might agree to call the endemic attended 
with one set of symptoms the plague, and with another the 

t Laray'g Memoirs, Amer. Edit. VoL L 



Origin, <f>c. of Endemic Feve^ 109* 

yellow fever; but whether designated by the term plague, 
yellow fever, malignant pestilential, bilious remittent, sea- 
soning fever, or any other, it is all the same disease, with 
the same remote and proximate causes, though diversified 
in aspect, by peculiarities of seasons and situations, the con- 
stitution of the patient, and the strength or weakness of the 
remote causes. And had not Baron Laray been so wedded 
to the nosology of the schools, as to be unwilling to give up 
the specific character of the plague, he would have viewed 
the disease in the same light as represented by Assalini. 

Dr. Mitchell, in a letter to Dr. Duncan, dated New- York, 
16th November, 1 798, among other symptoms of the yellow 
fever, which then spread terror through the city, mentions 
the appearance of buboes and carbuncles.* 

Similar glandular affections were observed by Dr. Rush 
and other physicians in the yellow fever of Philadelphia in 
1793.1 Anthraces, buboes, and carbuncles have likewise 
been observed in the yellow fever of the West Indies. J The 
frequent appearance of these local affections have procured 
for the yellow fever of America, in its more malignant char- 
acter, the appellation of the western plague. (Festis Occi- 
denlalis.) 

Col. Wilson, on the subject of the plague of Egypt, makes 
the following remarks. He says that the plague has long 
been supposed to have been brought from Turkey in the 
ships charged with old clothes, which constantly came to 
Alexandria for market. "But the plague," says he, "has 
been generated annually in Egypt during the last four years, 
(although no such communication has been possible,) and 
even chiefly communicated in Upper Egypt. In Cairo, last 
year, forty thousand people were supposed to be infected 
with the plague, and many of the French garrison in that 
city died, although the disease was treated in their hospitals 
with the greatest ability. In Upper Egypt, 60,000 of the 
inhabitants perished during the same season. Three whole 
villages were swept away? and remained abandoned when 
the Indian army descended the Nile." 

If we take into consideration the physical condition of 
the country, we shall find enough to answer our purpose in 
accounting for the origin of the plague in Egypt, without 

* Duncan's Annals of Medicine, Vol. IV. p. 340. 

t Rush's Inqu. & Obs. Vol. Ill, p. 124. 

% See a letter from Dr. George Davidson, dated Fort Royal, Martinique. 
Sept. 20, 1796, to James Mease, M. D. resident physician of the port of Phi- 
ladelphia. Med Repos. 



1 10 Origin, #c. of Endemic Fever. 

ascribing it to the old clothes imported from Constantino.* 
pie. 

The principal source of disease in Egypt was represent- 
ed in chapter 1st, section 5th, to be the annual overflowing 
of the Nile, leaving, on its subsidence, a quantity of putrid 
matters exposed to the action of the sun, filling the air with 
putrid and offensive vapors; to which were added the filth 
and poverty of the inhabitants ; their small, ill ventilated 
and dirty houses; crowded, narrow and filthy streets, &c. 

I here subjoin a short review of Prosper Alpinus* work, 
DeMed. Egyplior. lib. 1, in relation to the plague of Egypt : 
for which I am indebted to the Medical Repository, Vol. IV. 
page 195. Alpinus informs us, (cap. 13.) that an almost 
infinite number of Egyptians, impelled by poverty and want, 
fed upon the worst kind of aliment, and drank muddy and 
putrid water, at Cairo. The Mahometans used wine very 
commonly, and got drunk as well as the Christians and Jews. 
The houses of that city are very high, and are constructed 
go as to shelve over the streets, and exclude sunshine and 
Jight. (cap. 6.) At Alexandria, pestilential fevers happen- 
ed almost every autumn, and were more destructive to 
strangers than to the natives, (cap. 14.) P. Alpinus takes 
up almost a page in enumerating local causes of this disease, 
such as the corrupt exhalations from Lake Mareotis and its 
neighborhood ; from low places and sunken holes in the city 
itself; from the water of the Nile conducted to the town, 
drawn off into stagnant reservoirs, kept during the year for 
family use, sometimes growing poisonous before it was con- 
sumed, and used in this condition for cookery and drinking, 
&c. He mentions the canal of Cairo as an abominable nui- 
sance, as becoming charged with abundance of putrefying 
things, changing from green to black, and becoming horribly 
stinking, and destroying the lives of persons living near it. 
He describes the diet of the poor, (in a society where almost 
all are poor.) as consisting of muddy and corrupted water, 
and half rotten beef, camel's flesh, fish and cheese, eaten by 
them because they are cheapest, and because they can buy 
no other. After all this, Alpinus admits, though with seem- 
ing reluctance, that the pestilential contagion may be en- 
gendered from putrefaction, in certain places, after the wa- 
ters of the swollen Nile have withdrawn. But he thinks, 
upon the whole, the contagion is commonly imported, either 
from Greece, Syria or Barbary, and that the contagion from 
Barbary is by far the worst!! It rages from September to 
June, and then stops spontaneously, when the Etesian or 
cool northerly winds begin to blow. 



Origin, &c. of Endemic Fever. Ill 

It was the practice of the ancient historians, as medical 
writers to give the denomination of plague to all epidemical 
diseases which proved remarkably destructive ; and Mr. 
Ceresole, one of the physicians of Bonaparte's army, relates 
that the word koubeh, in Arabic, which, in English, is trans- 
lated plague, is a general denomination applied to every vi- 
olent and malignant disease. Desgenettes, the physician 
general of the French army in Egypt, informs us, that in 
Egypt they generally confound all pestilential fevers, which 
are exceedingly various, with the plague properly so called: 
which like all the advocates for contagion, and the peculiar 
specific nature of diseases, he considers as a very circum- 
scribed species.* The truth is, says the editor of the Med- 
ical Repository, there is no proof of the existence of such a 
specific disease as the pes lis of nosologists, and the plague of 
the commercial nations of Europe. The accounts they give 
of it are imperfect in some respects, and fictitious in others. 
The fevers of Asia and Africa, like those of America, take 
on a hundred different forms, arise from the like causes, and 
die away under similar circumstances. If buboes, and he- 
morrhages, and mortifications, are criteria of the plague, 
then we certainly have the plague in the United States. t 

The plague which prevailed in Marseilles in 1720, origin- 
ated from a scarcity of food, and was afterwards increased 
by the dead bodies which were left unburied in the streets. 
As soon as the disease was declared to be contagious, tieser- 
tion, famine, disease and death spread desolation through 
the city. About a thousand corpses were daily thrown into 
the streets to putrefy, until at length a passenger could 
scarcely walk without treading on them : these, together 
with the putrefaction of dogs, which had been ordered to be 
killed, filled the air with their stinking and pestilential ex- 
halations. This shocking scene of misery and destruction 
continued until towards the end of September. And when 
we take into consideration the extraordinary concurrence of 
causes, we are not surprised that out of a population of 
80,000 inhabitants, 50,000 should have fallen a sacrifice to 
this pestilential mortality. J 

Ethiopia and Egypt, says Mr. Gibbon, § have been stig- 
matized in every age, as the original source and seminary 
of the plague. In damp, hot, stagnating air, this African 

* Un espece bien circonscrite. 
+ Med. Repos. Vol. IV. p. 194. 

X See the Introduction to Assalini on the Plague, by the American pub- 
lishers. 

£ Hist of the Decline and Fall of the Roman Empire, Vol. V. chap, xliii-. 



1 1 2 Origin, #•£. of Endemic Fevef. 

fever is generated from the putrefaction of animal substan- 
ces, (he should have added, and vegetable,) and especially 
from swarms of locusts, not less destructive to mankind in 
their death than in their lives. The fatal disease which 
depopulated the earth in the time of Justinian and his suc- 
cessors, first appeared in the neighborhood of Pelusium, be- 
tween the Serbonian bog and the eastern channel of the 
Nile. Mr. Gibbon goes on to describe its progress over 
Syria, Persia, the Indies, Africa, and Europe. To preg- 
nant women the plague was generally mortal : yet one in* 
fant was drawn alive from its dead mother, and three moth- 
ers survived the loss of their infected foetus. Youth wag 
the most perilous season ; and the female sex was less sus- 
ceptible than the male; but every rank and profession was 
attacked with indiscriminate rage, and many of those who 
escaped were deprived of the use of their speech, without 
being secure from a return of the disorder. "Besides its 
being propagated by the intercourse of war, the pestilential 
odour," says Mr. Gibbon, "which lurks for years in a bale 
of cotton, was imported by the abuse of trade, into the most 
distant regions. "* 

Yet Procopius himself, an eye witness, was satis- 
fied that the disease could not be communicated by the 
closest conversation.! In opposition to this opinion of im- 
ported contagion, it should be recollected that the Ro- 
mans, though they held no commercial intercourse with the 
rest of the world till after the subjugation of Carthage, were 
nevertheless subject to the ravages of the most destructive 
epidemics* As the causes of these, we need but refer to 
Lancissi's account of the marshes and noxious exhalations 
of the papal dominion, or to the descriptions given by Taei* 
tus and Livy of the swamps and low grounds of the Roman 
territory. 

"No facts," says Mr. Gibbon in a subsequent sentence, 
" have been preserved to sustain an account, or even a con- 
jecture, of the numbers that perished of this extraordinary 
mortality. I only find," says our author, " that during three 
rnonth«, five, and at length ten thousand persons died each 
day at Constantinople: that many cities of the east were 
left vacant, and that in several districts of Italy the harvest 
and vintage withered on the ground." Those who were 

* Mr. Gibbon, though well qualified to give interest and instruction upon 
every subject of general literature, was still, no doubt, a better historian 
than physician ; and it appears evident that he had imbibed the prevalent 
European prejudices of his day in relation to the subject of contagion. 

t Outc gar iatro, oute gar idiote. 



Origin, fyc» of Endemic fever, 113 

left without friends or servants, lay unburied in the streets, 
or in their desolate houses. Such was the universal corrup- 
tion of the air, that the pestilence which burst forth in the 
fifteenth year of Justinian, was not checked nor alleviated 
by any difference of the seasons. At times, its malignity 
was abated and dispersed ; the disease alternately languish- 
ed and revived ; but it was not till the end of the calamitous 
period of fifty-two years, that mankind recovered their 
health, or the air resumed its pure and salubrious quality. 
The triple scourge of war, pestilence and famine, afflicted 
the subjects of Justinian, and his reign is distinguished and 
disgraced by a visible decrease in the number of the human 
race ; a decrease which has never been repaired in some of 
the finest countries of the globe." 

It is probable that if we possessed a correct history of 
this destructive epidemic, as it appeared in different coun- 
tries, we should be able to account for its cotemporaneous 
prevalence in different places on philosophical principles; 
and might be able to trace it to a general cause, or pestilen- 
tial state of the atmosphere, as influenced by heat, moisture* 
putrefaction and peculiarity of season, without ascribing it to 
the influence of contagion, which can never be admitted 
as the cause of epidemical diseases. Such, indeed, is the 
rational presumption which we should make, from what we 
observe in our own time of the simultaneous rise and prev- 
alence of endemic fevers in different districts and sections 
of country, as well in America, as in the Eastern world. — 
The same season and circumstances that prove favourable to 
the origin of an epidemic in one place, will have the same 
influence in generating disease in a thousand different pla- 
ces at the same time : the circumstance is of easy and satis- 
factory solution, and the explanation is supported by phi- 
losophy and facts. We know that the plague which annu- 
ally prevails in different parts of Turkey, Syria, and Egypt, 
arises from the physical causes which have been already 
noticed. In Rome we trace this disorder to the inundation 
of the Tyber, and to the marshes and low grounds in the 
vicinity of the city. In a season of excessive rains, we are 
informed, the Tyber swelled above its banks, and rushed 
with irresistible violence into thevallies of the seven hills. 
A pestilential disease arose from the stagnation of the del- 
uge, and so violent was the infection, that four score per- 
sons expired in an hour in the midst of a solemn procession^ 
which implored the mercy of Heaven.* 

* Gibbon's Dec. and Fall, chap, XIV, 



114 Origin, tyc. of Endemic Fever, 

The plague has never been known as such on its first ap- 
pearance, and its being preceded and intimately connected 
with malignant fevers is noticed by a variety of authors, who, 
prejudiced in favour of the specific character of I he plague, 
look upon it as a peculiar and distinct disorder, different 
from the malignant fevers, its antecedents and successors ; 
which, in truth are but inferior grades of the same disease. 
The circumstance of this connexion was observed by Diern- 
erbroeck, in the plague at Niemeguen in 1635, and by Syden- 
ham, in 1665 : the same thing was observed in relation to 
the plague at Marseilles, (Traite de la Peste :) at Halstein, 
(Woldshmidt.) in 1764; and at Moscow, (Mertens,) in 1771. 
Morton, speaking of the poison that produced the remittent 
fever, which prevailed in London for several years previous 
to 1665, says, the poison having collected and increased it- 
self in a wonderful manner, unexpectedly changed into the. 
most dreadful and fatal plague.* The same gradual tran- 
sition, or rather mitigation of symptoms, has been observed 
in the decline of the plague as in its aggravation, passing 
a°"ain into its former ambiguous character. The fevers, says 
Sydenham, which succeed a severe plague are in some in- 
stances of an aggravated and pestilential character; and, al- 
though destitute of some of the distinguishing maiks of the 
plague, nevertheless, frequently represent its own nature and 
appearance, and also require a similar method of treat- 
ment. Sir John Pringle relates, upon the authority of Dr. 
Mackenzie, who had resided thirty years at Constantinople, 
that the annual pestilential fever of that place, is only called 
the plague when attended with buboes and carbuncles ;t 
and, Dr. Russel informs us, that in Syria, during the winter 
and early part of the spring, the distinguishing marks of 
this disease, as buboes and carbuncles, are often absent,]: — > 
We are told by Mertens, that a putrid fever had been epi- 
demic at Moscow for three years preceding the plague ; but* 
that as soon as the plague broke out, the fever ceased : or, 
with more propriety, it might be said, that as soon as they 
agreed to call the disease by the name of the plague, no 
other disorder was acknowledged. 

Sydenham, speaking of the malignant fever which usher- 
ed in the plague of 1665, says that it assumed the very as- 
pect of the plague, nor could it be distinguished from that 
disease, but by being less aggravated in degree. § A similar 

*ln pestem funestissimam et dirissirnam inopinale mulavlt. 

+ Pringle on the Diseases of the Army. 

jf. Russel on the Plague. 

5 Nec ab ea nisi ob gradual reraisiorem descriminalur. 



Origin, 4-c of Endemic Fever, I i 5 

observation has been made by Rothman, in his account of 
the plague at Stockholm in 1710 : that the malignant fever 
differed from the plague in nothing but degree. Dr. Meed 
speaks of biles and painful suppurating tumors in the groins 
and axilla in the small pox. Glandular swellings were also 
noticed in the yellow fever in Philadelphia, in 1 793 ; also, in 
the yellow fever of New- York, in 1798; and in several 
other instances. Sir John Pringle, Dr. Lind and Dr. Don* 
aid Monro, mention the appearance of the swelling and sup- 
puration of the parotid glands in the malignant fevers which 
fell under their observation. 

As the plague is nothing more nor less, than a highly ma- 
lignant grade of fever, we can see no propriety in this par- 
ticular distinction, either for the elucidation of its nature, 
or for the purposes of prevention and cure. Diseases of 
uncommon fatality have generally received the terrific ap- 
pellation of the plague : thus an epidemic fever of a remit- 
tent type, at first divested of malignity, has, by the progres- 
sive severity of its symptoms and the mortality which attend- 
ed its more aggravated form, at length received this dreadful 
and appalling distinction. In the year 1 804, Spain suffered a 
diminution in her population of one million of inhabitants, 
principally from the bilious yellow fever, or plague as it was 
called. In Malaga, as early as the 1 1th of August, 1804, the 
deaths from yellow fever amounted to 50 a day.* On the 1 4th 
of the same month, the deaths had considerably diminished, 
and all the physicians of the place subscribed a written opin- 
ion in the following words before the magistrates. " W# 
the undersigned physicians certify, that no epidemical dis- 
ease prevails at Malaga at present. It is a sort of ague or 
malignant fever, similar to that which rages in many other 
parts of Spain ; and it has of late so much subsided, that 
out of twenty people taken ill, only five died, whilst on the 
first appearance 15 out of 20. We hope that by the use of 
gentle medicine, and by taking the necessary precautions of 
fumigating the houses where the disease has existed, it wiil 
soon disappear." From the publications of that time, it ap- 
pears that this ague, or malignant fever, was on the 18th of 
August called a contagious fever, and, as it still continued to 
increase in malignancy and extent, on the 22d they called 
it the plague ; the number of deaths the preceding day hav- 
ing amounted to 1 48. As soon as the disorder was pronounc- 
ed contagious and to be the plague, all intercourse between 

* Med. Repos. vo. 8, p. 430. Malaga is situated in 36° 48' ■ N. Eu 



1 1 6 Origin, fyc. of Endemic Fever. 

the town and country was prohibited. And such was the 
alarm and consternation of the people, that the tragic scenes 
exhibited at Messina on a like occasion, were acted over 
again at Malaga. At Messina we are told, that as soon as 
the sickness was declared to be the plague, the inhabitants 
were panic struck. There were no bakers to prepare bread, 
there were no labourers to dig graves, there were no nurses 
to attend the sick, and as the disease was deemed conta- 
gious, every person was afraid to touch another, and even 
to come near him. The people of the surrounding country 
refused to bring fruit or provisions to marker, and guarded 
the roads leading out of town with so much strictness as to 
prevent the flight of the unhappy citizens into the country. 
The putrefying carcasses of the dead, lay scattered through 
the houses, heaped in the streets, and piled in large collec- 
tions at the church doors. Such was the stench and horror 
produced by the putrefying carcases, that at length the fur- 
niture and wood work of the houses were carried into 
streets for the purpose of making fires to consume them. 
From these funeral piles, fire was several times communi- 
cated to the houses. Forty thousand persons, out of a pop- 
ulation of 60,000, perished by this calamity. 

The following extract of a letter, dated, Malaga, Decem- 
ber 1804, will give some additional idea of the ravages of 
this disorder. ." It is impossible to form a just idea of the 
aspect exhibited by our unfortunate city. It resembles a 
desert. The mortality here, has, in some measure ceased, 
it is true, for want of victims. Seven thousand persons only 
have escaped its attack ; twenty-six thousand have fallen a 
sacrifice to it." 

Dr. Valentine, in his essay on the yellow fever in Spain, 
in 1804, gives the following information concerning its fatali- 
ty. " Malaga, which contained a population of 1 10,000, lost 
26,000 by this pestilence." Sixteen cities and a number of 
villages suffered from this epidemic. At Carihagena, 14,000 
died, out of a population of about 31,000. At Malaga, 
26,050 persons we are informed by the London Monthly 
Magazine, for February 1805, were buried in the course of 
four weeks. By a letter from Mr. Kenning, surgeon of the 
royal artillery, to Dr. Rollo, published in the Medical and 
Physical Journal of London, for March 1805, we learn that 
one half of a garrison of soldiers, consisting of 12,000, sta- 
tioned at Gibraltar, died of this disease. "The tenth regi* 
ment," says he, " have lost only two or three men of those 
who have been in the East Indies ; and wery few indeed of 



Origin fyc. of Endemic Fever. 117 

their recruits recovered ; which evidently shows that the cli- 
mate has done more for them than medical aid. 

It is wortny of remark, says Dr. Heberden,* how, ac- 
cording to the bills of mortality in general, but espe- 
cially the spotted fever, always increased and decreas- 
ed along with the plague. Of the former, there never died 
more than four in a week before the plague began ; but after- 
wards the number frequently exceeded a hundred. Nor was 
this by any means peculiar to London. Diemerbroeck relates 
the same of the plague in the Netherlands; and Gorkelius 
is quoted by Brown, as having observed a similar occurrence; 
and more particularly Berwinkle, who was a physician at 
Hamburg during the plague, in the year 1714, who observes 
that the petechial fever and plague were frequently con- 
verted into each other, and that if the buboes retroceded, 
a petechial fever, in general, arose. From which he gathers, 
that the nature of buboes and petechial fever were either 
one and the same disease, or differed very slightly.! Roth- 
man, in his history of the plague of Stockholm in 1710, says 
no one doubts the existence of plague, meiely from the ab- 
sence of buboes, carbuncles, blotches, &c.| In Joseph 
Brown's treatise on the plague, are mentioned the special 
signs of persons infected with the plague, according to Lu- 
dovicus Gordinius and Eberhardus Gorkelius, which 3 re no 
other than such as are common to all malignant fevers : no 
mention is made of buboes or carbuncles, till we arrive at 
the succeeding chapter, " the signs of death." In the 
great plague of London, it is said, " the practitioners in 
physic stood amazed, to meet with so many various symp- 
toms, which they found among the patients : one week, the 
general distempers are blotches and buboes ; the next week, 
as clean skined as may be ; but death spares neither : one 
week full of spots and tokens | and perhaps the succeeding 
bill none at a!l. ?5 § 

Jn the plague of Messina, in Sicily, in 1743, the physi- 
cians sent to examine the sick, reported, that the disorder 
was nothing more than the epidemic which had prevailed 
since February. This opinion they grounded on the fact, 

* Obs. on the Increase and Decrease of Different Disease?, and particu- 
larly of the Plague. Lond. 1801. 

t Parum tamen dififerentem. 

| Duri autem revera pe?tera sine bubone, carbonato, macula, &c. non est 
quod quis dubitat. 

(| Extract of a Letter from John Tillison, September 14, 1665, to Dr. 
Sancroft; preserved in the British Museum, no. 378»; quoted by Heber- 
den. 



118 Origin, 4*c. of Endemic Fever. 

that the disease was not contagious, nor communicable (torn 
one person to another. From this circumstance they con- 
cluded it could not be the plague, whose essential charac- 
ter, they saidj was to be highly contagious. Physicians? 
surgeons, confessors and barbers, generally escaped it. 
though they attended the sick in the hospitals. The dis- 
temper, however, continued to increase with so much vio- 
lence and mortality, that on the 4th of June, it was allow- 
ed by all parties to be the true plague. Known by this ter- 
rific appelation, the disease was afterwards deemed conta- 
gious. 

Professor Thomas Fasano, published a book at Naples, 
on the epidemic fever which desolated that city in 1764.— 
It is entitled Delia Febre Epidernka Sofferia in Napoli I An- 
no 1764, Libra iii. Di Tomasso Fasano. " He is so wholly- 
convinced of the local and domestic origin, that he does not 
even mention any thing about a ship." And this in a sea- 
port, says Dr. MitchiD, is a very remarkable circumstance. 
With much good sense. Fasano lays it down as a principle, 
that an epidemic is a slight plague, and that a plague is a 
powerful and furious epidemic. And in like manner, Michael 
Sarcone, who wrote a history, in two volumes, of the dis- 
temper which prevailed at Naples, in 1764, under the title 
of Istoria Ragiomata di Mali osservati in Kapoli neW intero 
cotfo dell 9 Anno 1764, does not pretend that this epidemic 
was any thing else than a pestilence, consequent upon the 
extreme scarcity and famine of the preceding year.* 

The pestilence which prevailed in the French army at 
Jaffa is judiciously ascribed by Assalani, to the circumstan- 
ces of their situation. The water of the Nile, and the want 
of ditches to drain the ground, occasioned several ponds or 
marshes, which could only be carried off by evaporation. — 
The French army on its arrival at Jaffa, encamped close to 
one of these ponds, the water of which supplied their wants, 
till their departure for Acre. On the taking of Jaffa, by 
assault, the number of Turks killed and half buried ; the 
bodies of those which the sea threw back, and left on the 
shores ; the miasmata arising from the putrefaction of the 
horses and camels, left dead upon the ground, or dragged 
scarcely beyond trie wails; the want of fresh provisions; 
the filthiness of the inhabitants, the hordes of Bedouin Arabs 
who blockaded the city, formed a combination of circum- 
stances, from which the army in a few days was overwhelm- 

* See the introduction to Assalini on the Plague, by the American Pub- 
lishers. 



Origin, fyc. of Endemic Fever, 119 

ed with all the horrors of war, famine and pestilence.* — 
Assalani himself, prefers calling this disease by the name of 
the epidemic fever. 

The plague, spotted fever, scurvy, and other malignant 
diseases which prevailed in London in the 16th century, 
seem to have originated from causes similar to those above 
mentioned ; and from the nature of the diet of the inhabi- 
tants, which consisted principally of animal food, and the 
filihiness of the streets and houses. Erasmus, in a letter to 
Franciscus, Cardinal Wolsey's physician, ascribes the sweat- 
ing sickness, a species of plague, from which the English 
were scarcely ever free, in a great measure, to the incom- 
modious form and bad exposure of their houses, and to the 
sluttisbness within doors. The cabins were constructed of 
mud and clay, and served as common sinks for all kinds of 
tilth ; such as the matter rejected by vomiting, the urine 
of men and dogs, soup and dish water thrown upon the 
floor, the cleanings of fish and other sordes too shocking 
to mention.! In 1389, the streets of London were so 
abused by the dung and garbage of the common lay stalls, 
to the great annoyance of the citizens, that a proclamation 
was made throughout the city by authority of parliament, 
" that no person whatever presume to lay any dung, guts, 
garbage, offals, or any other ordure, in any street, ditch, 
river, &c. upon penalty of twenty pounds, to be recovered 
by any information in chancery." When the plague pre- 
vailed in London in 1569, orders were issued "to warn all 
inhabitants, against their houses, to keep chanels clean 
from tilth, by only turning yt asyde, that the water may 
have passage." From these circumstances, we are not sur- 
prised that the city was overrun with epidemical diseases ; 
which according to the season, and the strength of the re- 
mote causes, assumed different appearances. It is said by 
Burnet, in his history of the reformation, that in the last year 
of Queen Mary's reign, "intermitting fevers were so uni- 
versal and contagious, that they raged like a plague." We 
are informed by Morton, that remittent fevers were very 
destructive for several years before the great plague of 
1665. In 1658, Oliver Cromwell died of this fever; and 
he says that the death of his own father was also occasioned 
by this disease, which likewise affected his whole family. 
He proceeds to say, that the cold weather aftei wards check- 

* Assalani on the disease called the Plagfte, Amer. Edit. p. >°» & !». 
t Foveas pputi i, vomitus, mictum canmn et honiinuuh projectam cere- 
$t$eia.tzi, et pisceum reliqua», aliasque sordes nan nomiuHudos. 



t 20 Origin, ire, of Endemic Fever. 

ed ibis disorder; yet the seeds of it were by no means de- 
stroyed, and continued to show themselves under different 
forms. He observes, that during the winter, intermittents, 
quartans, tertians and quotidians, arose from a milder de- 
gree of the same poison, and were almost equally epidemic, 
as the continued or remittents were in autumn. And that 
the same fever under the continued type, more especially 
in the character of a simple and legitimate quotidian or ter- 
tian, was very common ; and in autumn he observed it to be 
more or less epidemic, till the year 1664. He informs us, 
likewise, that in the two years immediately succeeding the 
great plague, dysenteries were very frequent, and we are 
afterwards told that the same disease returned every au- 
tumn, attended nearly by the same mortality. Maj. Grant, 
whose observations on the British mortality were published 
in 1662, say's, 4> the diseases, besides the plague, which make 
years uuhealthful in this city, are, spotted fever, small pox, 
dysentery, called by some the plague in the guts; and the 
unheahhful season is autumn. At the approach of winter 
the plague subsided ; and the morbific causes operated in a 
milder way by producing agues, and other diseases of a less 
aggravated character than those of autumn. We are in- 
formed by Sydenham, that from 1661 to 1664, agues were 
epidemical in London, and again from 1677 to 1685. From 
the same author we also learn that dysentery was epidemi- 
cal four years together; and the bills of mortality show the 
sum of deaths under the title of bloody flux and griping in 
the guts, in some years to have exceeded 4,000; and for 
five and twenty years successively, from 1667 to 1692, the 
number each year amounts to above 2,000. 

The principal circumstance worthy of notice in the above 
account, is the striking connexion existing between what 
was called the plague and intermitting fever ; from which 
we learn that the endemic fever, upon becoming milder and 
less malignant, assumed the intermitting type, more espe- 
cially upon the approach of cool weather, and in certain 
years, when the causes were not sufficiently powerful to 
produce the more aggravated forms of disease. 

Such was the want of delicacy and improvement among 
the Europeans, at the time here alluded to, and such their 
ignorance of the operation and effects of natural causes, that 
the neglect of cleanliness was not considered either as a 
physical or moral evil : and we accordingly rind that the 
same causes of disease prevailed in almost every town and 
village throughout the kingdom. From a similar neglect of 
cleanliness, and from accumulation of filth, the same dig- 



Origin, fyc of Endemic Fever, 121 

eases likewise prevailed at Oxford. To the preceding cir- 
cumstances is to be attributed the scurvy which was fre- 
quently epidemic in England. Hodges, in his account of 
the plague in 16Q5, says, that "a scorbutic affection was 
very epidemic amongst them*" And Hurtzner, in his trav- 
els at the time of Queen Elizabeth, remarks that " the Eng- 
lish are often molested by the scurvy." Willis, who wrote 
a particular treatise upon this subject, describes it as an en- 
demic in many parts of England, and almost every where 
sporadic. And Chariton represents the scurvy as an en- 
demic disease. 

One great cause of the diseases of London, it was ob- 
served, was the narrowness of the streets ; in which filth of 
every description was permitted to accumulate: and the 
great fire, which, at the time, was considered a calamity, 
was doubtless an occurrence of national prosperity and hap- 
piness, and an event of providential goodness. The inhabi- 
tants, emerging from their supineness, ignorance and filthy 
profited by the experience of the past : the streets of the 
rising city were made straight and spacious : cleanliness was 
enforced; and as a reward for their sufferings, plague, dys- 
entery, scurvy, &c. rapidly declined ; so that, in a few years, 
the pestilence which had so long; spread wretchedness and 
desolation through the streets of London, was known only 
by name. 

From those authors who have given a circumstantial ac- 
count of the plague, as it prevailed in other parts of Europe, 
it appears that the same causes every where contributed to 
its production. These causes are principally to be found 
in the political calamities of the country, and in the manners 
and habits of society. In illustration of this point, see the 
account of the plague of Denmark in 1690, by Thomas Bar- 
tholine ; that of Cologne, and Paris in 1570, by Forestus ; 
that of Toulouse and Marseilles, by Diemerhroeck : and the 
Traite de la Peste. The progress of civilization in the na- 
tions of Europe, their improvement in the comforts of do- 
mestic life, their cultivation of the arts of peace and agricul- 
tural economy, and the light of science, have changed the 
physical aspect of the nation, and instead of noxious marshes, 
polluted kennels, offensive streets, and dirty houses, and 
their baleful progeny of diseases, cheerfulness and beauty 
smile upon the face of nature, and health follows as the re- 
ward of industry, cleanliness and virtue.* 

* The words industry, cleanliness and virfuc. are used in a relative, aot 
an absolute sense. 

Q 



122 'Origin, fyc, of Endemic Fever, 

Considering the baseness of its origin and the stigma of 
its parentage, it is not surprising that none wii! acknowledge 
the plague as an offspring of their own country ; like an ex- 
communicated and wretched outcast, it has, accordingly, 
found no quarter. Villani, who spent some time and labor 
in investigating the origin of a great plague in the fourteenth 
century, was at last referred to China, and was told that it 
was there occasioned by the bursting of a huge ball of fire 
attended with uncommon stench. 

A pleasing and salutary effect of the improvement of phi- 
losophy and medical science, may be observed in the health 
and happiness of a civilized country, where no irremediable 
causes of diseases exist. The discreet and intelligent phy- 
sician detects the seeds and principles of disease in the lurk- 
ing places of their generation, directs the remedy, and de- 
stroys the viper before maturity and the fostering hand of 
ignorance have furnished him with the fangs and venom of 
destruction. But what shall we say of those, who, in quest 
of a delusive phantom, turn their eyes from the light of truth 
and nature, and fix them on inanity? Such are those who 
denying the domestic origin of yellow and endemic fevers, 
by whatever name they may be called, search for the fan- 
cied germ in a bag of cotton from the south, or in a pair of 
old breeches from Constantinople, or finally in the offensive 
hold of such a vessel as Dr. Chisbolrn's ship Hankey. Un- 
happily for themselves and their disciples, under the error 
of ignorance, the delusion of prejudice, or the pride of dog- 
matical opinion, they fix their view upon an imaginary evil, 
and overlook the danger which surrounds them. 

Let us once more direct our observation to those unhappy 
countries, where ignorance and superstition lend their aid to 
the destructive operation of physical evils. Are these evils, 
in all climates and situations, inevitable, or do they consist 
in many instances, in obvious and remediable circumstances? 
So obvious, that those who have the use of sight and smell 
cannot mistake the demonstration of their senses. Yet some 
there are, who like the skeptic philosophers of old, reject 
the evidence c-^ palpable objects as mere seemings, and what 
is imperceptible and imaginary they consider real. 

It is observed that the plague seldom or never breaks out 
in Constantinople in the houses of the opulent, or in such as 
are kept clean ; and it prevails principally, and at all times, 
ill the lodgings of the lower orders, which are generally kept 
in a state of excessive filthiness ; the narrow, confined streets 
are in no better order, and are generally strewed with the 
remains of animal and vegetable substances. 



Origin, <£*c. of Endemic Feve?^ 1 2# 

The superstition, carelessness and ignorance of the Egyp- 
tians, serve to increase the physical evils of their country; 
which may be gathered from the present more frequent visi- 
tations of the plague than formerly. Savary asserts, that 
two hundred persons in Grand Cairo occupy less space than 
thirty in Paris. The streets are so narrow and full of peo- 
ple, that they jostle against each other, and sometimes a 
man is obliged to wait some minutes before he can make his 
way. Yet this same author, says Mr. Webster, alleges the 
plague not to be a native of Egypt. Baron Larrey considers 
the plague as an endemic, not only of the coast of Syria, but 
also of the towns of Alexandria, Damietta, Rosetta, and of 
the other parts of Lower Egypt; and remarks that the truth 
of this opinion will appear evident on taking into considera- 
tion the structure of their cities, the streets of which are 
narrow, crooked and unpaved, the houses badly construct- 
ed, and most of them filled with rubbish; besides this, each 
causeway forms a dam, in which the rain water collects 
and stagnates : this is more particularly the case in the ma- 
ritime towns and in Damietta, on account of the surface of 
the earth being beneath the level of the sea. In addition to 
all this, are ihe surrounding lakes, and the swampy and nox- 
ious rice fields ; the prevalence of the warm and moist south 
winds, which continue till the end of May : to which may 
be added, the want of cleanliness among the inhabitants, 
their bad diet and inactive life, the putrefaction of multi- 
tudes of dead dogs and other animals left in the causeways ; 
the number of badly constructed cemeteries in the vicinity 
of the cities, in which the Turks leave an opening to the 
east, to communicate with the corpses thus giving vent to 
(he gas which is formed, and increasing the impurity of the 
air. Our author further informs us, that at Alexandria, also, 
where the plague prevailed the first year with great mor- 
tality, many men and inferior animals were killed, their 
corpses were left lying on the ground, or were half buried 
beneath the ramparts, and contributed to the production of 
this disease. "At El Arych," says Baron Laney, "we \ott 
79 by the plague, of a garrison of 300; many animals which 
had been killed during the siege and were already putrefy- 
ing, were buried near the fort with too little precaution.— 
At Gaza the Mamelukes, in many parts of the town, left a 
great number of horses which died of an epidemic that pre- 
ceded the plague ; which according to the account given of 
it by the inhabitants, made dreadful havoc among them- 
selves, as well as among the Mamalukes. I tiave observed 



124 Origin, fyc. of Endemic Fever. 

that the plague rages with more violence during the preva- 
lence of the souih winds, than when they blow from the 
north or north west, in which case it diminishes, and rarely 
appears if the cold winds continue for a long time."'* Our 
author informs us, that (he same appearances were observ- 
ed upon dissection in the plague as in the yellow fever.-— 
The liver was found larger than natural; the gall bladder 
full of black bile. The truth of the matter appears to be, 
that the yellow fever and the plague of Egypt are the same 
disease. Or in other words, they are the common endemic 
fever of the country, and very similar to that of the United 
States. 

An account of a pestilential fever is recorded by Sir John 
Elliot, which originated in Naples in the summer of 1764 ; 
in consequence of the famine occasioned by a large expor- 
tation of corn. It is stated that 200,000, out of 2,000,000 
of inhabitants that the kingdom contained, perished by the 
disease. The inhabitants of Naples, we are informed, are 
extremely remiss in regard to cleanliness, both within 
and without their habitations, which, together with the heat 
of the climate, and want of food, our author thinks is suffi- 
cient to account for the calamity. In July, the disease be- 
came highly infectious, was attended with petechia?, swell- 
ings of tire parotid glands, obstinate delirium, violent vom- 
iting and fluxes of blood. It was observed that the sick 
who were removed into the hospitals which stood near the 
sea, recovered much quicker than in other places ; and that 
few of them died there. In those well ventilated hospitals, 
open to the sea air, the progress of the contagion was en- 
tirely stopped, and none of the nurses or attendants on the 
sick were infected with the distemper.! 

It has been commonly observed in the prevalence of epi- 
demic diseases, that the poor are the greatest sufferers, m 
consequence of their rilthiness, close and crowded habi- 
tations, and the numerous inconveniences and privations 
which they suffer. 

Orosius, in his account of the pestilence which prevailed 
in Rome, B. C. 461, observes, that though many of the pa- 
tricians were victims, it was more especially fatal to the 

* Lar. Mem. Amer. Edit. Vol. I. p. 189. 

t Lind on the Diseases incidental to Europeans in Hot Climstes, p. 199" 
ei seq. In the treainient of this disease, vegetable acids were given in 
large quantities. Ice water and bark, we are told, were the great reme- 
dies. Musk w r as likewise found extremely useful in relieving the head-ache. 
Mineral acids, where livid blotches and other high symptoms of putrefac- 
tion appeared, were administered with the best effeQt. 



Origin. <y-c. of Endemic Fever-. 125 

poor. It is also stated by Livy, in relation to the same dis- 
ease, that many persons of rank and affluence perished, but 
that among the poor and indigent its ravages were extensive. 
According to Diemerbroeck, it was the practice in Italy 
and France to expel the poor immediately from the towns 
upon the appearance of the plague. The plague which 
prevailed at Marseilles in 1720, appeared first in the west 
part of the town, inhabited by the poorest people.* At 
Aleppo, it always begins in the Kusarias and Judida ; the 
former are small huts, with few or no windows, which stand 
crowded together,- and are inhabited by the lowest Arabs; 
the latter are the dwellings of the inferior Jews, " whose 
houses are small; or if large, the different apartments are 
crowded with different families ; many of them are more 
than a story below the level of the street, in a condition half 
ruinous, dirty in the extreme, damp, and badly aired ; and 
the wretched inhabitants are clothed with rags.t In Hol- 
stein, in 1764, it first appeared at Rensburg, among the pris- 
oners, who, on account of offences, were condemned to pub- 
lic labor. | At Moscow it broke out in a very large house, 
which was used in baking bread for the soldiers ; three thou- 
sand persons of both sexes were employed in this occupa- 
tion, of whom the poorer portion, comprehending about one 
third, inhabited the inferior part of the building. § And the 
same author says that the plague which raged at Moscow 
was almost solely confined to the common people ; and that 
amongst the nobles and richer merchants scarcely any were 
attacked. In London, the plague in 1626, and 1636, broke 
out at White Chapel, a part of the town which abounded 
with poor, and with slaughter houses. We are told by 
Hodges, that the plague which prevailed in London in 
,1665, was entirely confined to the poor, on which account 
it was called by some the poor'' s plague. It is related by 
Lord Clarendon, that when he and other people of condi- 
tion, who had fled from the plague, returned to London, 
they scarcely missed one of their friends or acquaintances, 
the mortality having been confined almost entirely to the 
lowest orders of the people. 

London was subject to the plague at different times from 
1593 to 1666. The week ending the 5th of September, 



* Timon on the Plague of Constantinople. Phil Trans. Abr. Vol. VII. 
t City Remembrancer. 
^ Russel on the Plague. 

$ Waldschmidt de singularibus quibusdam Pestis Hoist. Haller Dispu- 
lat, Vol V. 



126' Origin, $c. of Endemic Fever* 

1665, 6.988 persons med of this disease; of 97,306 deaths 
in 1665. 68,590 were of the plague. The whole number of 
deaths this year amounted to 96.306, of which 68,596 were 
of the plague.* 

Previous (o the great fire in London, the streets were so 
narrow, and the stories of the buildings projected over each 
other so much, that the houses of the opposite sides of the 
streets nearly touched ; so as in a great measure to exclude, 
the light of da}, rendering the air clamp, stagnant and con- 
fined, and giving to the city the gloom and appearance of a 
vast dungeon. 

The plague which, for many years, afflicted (he Romans, 
was entirely of domestic origin. The marshes and low 
grounds, in the vicinity of (he city, as described by Tacitus 
and Livy, were no doubt the principal cause of this disorder. 
If to this be added the poverty of the common people, their 
crowded habitations, and frequent scarcity of provision, we 
»eed be at no loss to account for its production. At the 
time here alluded to, the Romans were ignorant of com- 
merce, nor did they own a single ship till more than two 
centuries afterward?. 

It has been contended by some, that the plague which 
raged at Athens, at the time of the Peloponnesian war, was 
an imported disease. Upon inquiry, however, we shall find 
that such a presumption is not authorized by historical facts y 
since every cause which has been known to contribute to 
the production of pestilence in other situations, existed, in 
a remarkable degree, at Athens. The city was crowded 
with people, who took refuge from the war. So that from 
a population of 50,000, the number was augmented to more 
than 400,000 inhabitants. Of such a multitude, a great 
portion were without houses to lodge in, and were crowded 
together in booths and temporary hovels. From the de-' 
struction of the harvest in the country, famine prevailed 
in the city, which added to the crowded state and confine- 
ment of the people, the accumulation of filth, want of habit- 
nal exercise, and an inclement season, soon spread pesti- 
lence and destruction through the city. 

The plague which prevailed in Rome B. C. 461, appears 
to have originated from similar causes. Livy represents 
the disease as being grievous and powerful, both in the coun- 
try and city, and equally severe upon man and beast. The 
disorder was aggravated in the city by the vast influx of peo- 

* Hebberdep'e Obs. on the increase and decrease of different Diseases, 
aoad particularly ot the Plague. 



Origin, #-c. of Endemic Fever, 1 27 

pie, flocks and herds, who fled for refuge from the enemy. 
The filth of such an assemblage of various animals, suffoca- 
ted the citizens with a stench to which they were unac- 
customed, whilst the populace from the country, crowded 
in narrow hovels, were still more distressed by heat and 
want of rest.* 



SECTION 2. 

Inquiry into the Doctrine of Contagion, Importation and Ex- 
otic Origin of the Yellow Fever/ 

The instances of simple fevers arising from contagion 
are so few, that the contagious nature of any of them can 
scarcely be considered as existing ; much less should it be 
an occasion of alarm or apprehension either to those whose 
duty and profession require their personal intercourse w r ith 
the diseased, or to friends who may visit them, or to nurses 
whose duty demands a constant attendance. In the course 
of several years experience in the fevers of hot countries, I 
never had reason to suspect a single case to have arisen 
from contagion. What proof, indeed, can be brought in 
support of the propagation of disease by contagion, when 
all are equally subject to the influence of a common cause? 
But if the limited extent of the endemic allows the patients 
to be removed to a wholesome air, and if in this situation 
the disease is not communicated either to nurses or others, 
there is then but little ground for considering it contagious. 
To jthis purpose we are informed by Dr. Rush that in the 
fever of 1793 many people who were infected in the city 
were attacked by the disease in the country, but they did 
not propagate it even to persons who slept in the same room 
with them.f 

The death of the adventurous and enterprising Dr. Valli, 
has, by some, been attributed to contagion. In the ardor of 
his pursuit and experimental reseaiches, and bidding defi- 
ance to contagion, he had the boldness, and a. petit maitre 
might say the indelicacy, to smell a dirty shirt in which a 
person had died of the yellow fever, and to rub it over dif- 
ferent parts of his naked body, as also to apply different 
parts of his own body in contact with th'e corpse - r as he 
was soon after seized with the fatal malady, there is some 

* Tit. Liv. lib. in. c. G. 

t I»q. aiad Qty*. Vol. HI. p, l§t& 



X^Z Origin, fyc. of Endemic Fever i 

argument for supposing that his disorder was occasioned 
by his presumptuous imprudence above mentioned. The 
communication on the subject by Dr. Frost was published 
in the Medical Repository and in the journals of the time ; 
and from the eminent character of Dr. Valli, his death be- 
came the subject of general conversation. Dr. Valli had 
extended his inquiries into Turkey, Syria, &c. in places 
the most infected with the plague; and from the circum- 
stance of his visiting in Havana the most unhealthy and ril- 
thy parts of (he city, anct^xposing himself to every source 
of infection, the probability is, that the efficient cause of his 
death was received from the atmosphere, in the course of 
his perambulations, inquiries and exposure. An instance is 
also related by Dr. Rush, of the yellow fever's having been 
communicated to a young man in Philadelphia, in conse- 
quence of opening a trunk of clothes, which had been the pro- 
perty of a Mr. Bingham who died of the disease in the West 
Indies, and of another person's taking the disease from the 
smell of a foul bed : but in neither of these cases was the fe- 
ver communicated to the family, friends or attendants of the 
persons thus infected.* I beg leave, however, to differ from 
the Doctor, when he says that " the matter which produced 
the fever in both these cases, had nothing specific in it ;" 
and that "if acted in the same manner that the exhalation 
from any other putrid matters would have done in a highly 
concentrated state." Though opposed to the doctrine of 
the specific nature of Contagion? as understood and inculca- 
ted by some physicians of eminence in our own country; 
yet, we know that it is the property of some malignant dis- 
eases to secrete a morbific matter from the body which is 
capable of producing disease of the same character in an- 
other person. This is exemplified in the small pox; in 
which it appears that the matter which escapes from the 
lungs and skin in the form of vapor, or adheres to the cloth- 
ing, is of the same nature as that which hardens into a con- 
crete consistence on the surface of the body ; and we are 
therefore led to conclude that wherever disease is taken 
from communication with the sick, or from articles that 
have been in contact with them, the matter producing the 
disorder must be imbued with the particular qualities of the 
complaint in which it was originally formed and evolved. 
Nor is it presumable that other matters, on as small a scale, 
in a state of putrefaction, equally, or even more offensive.. 

* Inq. and Obs. Vol. III. p. 94-5-. 



Origin, fyc. of Endemic Fever* 129 

would have produced the same effect as the clothes above 
mentioned. 

The reader will perceive that the above cases of infec- 
tion from foul clothing are admitted as facts : but, notwith- 
standing similar instances are related by a variety of authors, 
there can be no doubt that alarm, ignorance, and supersti- 
tion operating upon weak, ignorant, or prejudiced minds, 
have greatly enlarged the number of such occurrences be- 
yond the bounds of truth and probability. And I feel au- 
thorized to remark, that in all my intercourse with the sick, 
and in my familiarity with malignant diseases, I have never 
mot with an instance which could be attributed to the smell 
of an infected handkerchief, of a pair of gloves, or of old 
shoes, or finally to foul linen, clothing or furniture of any 
description. 

Assalini, who, as surgeon, accompanied the French army 
to Egypt, and who had there an opportunity of gaining cor- 
rect information on the subject of (he endemic malignant fe-' 
vers of the country, makes the following observations on this 
subject. " It has often been said, that in breaking open a 
letter, or in opening a bale of cotton, containing the germ of 
the plague, men have been struck down and killed by the 
pestilential vapor. I have never," he continues, " been 
able to meet with a single eye witness of this fact, notwith- 
standing the inquiries I have made in the lazarettos of Mar- 
seilles, of Toulon, of Guise, Spezzia, Leghorn, Malta, and 
the Levant. All agree in repeating that they have heard of 
such an occurrence, but that they have never seen it hap- 
pen. Among those whom I have interrogated about this 
fact, 1 may name citizen Martin, captain of the lazaretto of 
Marseilles, who for thirty years past has held that situation : 
this brave and respectable man told me (says Assalini) that 
during that time he had seen opened and emptied some 
millions of bales of cotton, silks, furs and other goods com- 
ing from several places where the plague raged, without 
ever having seen a single accident of the kind."* 

u Can. any person," says Dr. Moseley, "for a moment 
reflecting, believe that the great plague in London in 1665, 
which imagination traces from the Levant to Holland, and 
from Holland to England, was caused by the opening of a 
bag of cotton in the city, or in Long Acre ; or a package of 
hemp in St. Giles' parish. Is it possible to suppose that 
people should have been found to propagate or believe the 
well known and favorite stories of the advocates for Mead's 

* A?salini on the Epidemic Fever in Egypt, Amor. Edit. p. 1 & 3, 
K 



130 Origin, fyc.~ of Endemic Fever. 

theories. That a lady was killed immediately by smelling 
at a Turkey handkerchief, and a gentleman by only walk- 
ing over a Turkey carpet. ,? * 

During the last visitation of the plague in London, every 
town within twenty miles of that city was more or less in- 
fected ; and most of the principal towns in England, besides 
some parts of Ireland. Yet Oxford, which was previously 
drained and cleared, escaped, though the court removed 
thither, and no precautions were used to prevent the intro- 
duction of contagion from London. Dr. Piatt, very rea- 
sonably imputes this exemption to the draining and greater 
cleanliness of that city.t 

Hodges remained exempt from disease, notwithstanding 
his constant attendance upon the sick in the plague of Lon- 
don in 1665. Rhazes frequently practised in the plagues 
which were prevalent in his time, and lived, notwithstand- 
ing, to the protracted age of 120 years. Kaye practised 
with safety in the sweating sickness of 1551 ; and we are 
are informed by Procopius, that in the destructive plague 
which appeared in Constantinople in 154S, and which con- 
tinued for two or three years, producing an almost depopu- 
lation of the city, no physician, nurse or attendant on the 
sick took the disease. Yet during the prevalence of the 
plague at Marseilles, most of the Capuchins, the Jesuits, the 
Dominicans, and various other denominations of monks and 
friars, who lived secluded in their convents, and avoided all 
exposure and communication with the sick, took the disease 
and died.} 

Prince Ypsilanda, Hopodar of Wallnchia, in a letter to 
Dr. Carro of Vienna, dated Bucharest, July 25th, 1804, on 
the subject of the plague, observes: "The Imans exercise 
acts of charity with the most religious fervor. One may 
observe some of them, after having washed, wiped and bu- 
ried thousands of pestiferous persons, without experiencing 
the least accident, seized with it, and die at the time when 
they were least exposed to the contagion." 

We are informed by Col. Wilson, who was attached to 
the British army in Egypt, that the English and Turkish ar- 
mies which marched to Cairo, passed through a country 
where the plague filled almost every village i they commu- 
nicated, without any precaution, in the most intimate man- 
ner with the natives ; established their ovens at Menouf, 

* Moseley's Medical Tracts, p. 242. 

t Hebberden on the Increase and Decrease of certain Disease?, p. 80. 

| Journal de la Contagion a Marseilles. 



Origin, fyc. of Endemic Fever, 131 

where the plague raged violently: the Turks even rifled 
the diseased in the pest-houses at Ramanich, and at Cairo 
dug up the corpses recently buried, and yet no individual in- 
stance occurred of the malady in the armies. 

Dr. Russel, in his account of the plague of Aleppo, gives 
a relation of twelve families, in easy circumstances, infect- 
ed by the plague, and who did not communicate the disease, 
though they were nursed with the greatest care, and with- 
out the least precaution, as to personal safety, on the part 
of the attendants. 

From facts which may be relied upon with the greatest 
confidence, there appears, therefore, to be but little reason 
for apprehending the contagion of the plague, admitting the 
existence of such a specific disease. Even the advocates of 
its contagious nature say that contact is absolutely necessary 
to its propagation ; and here the opinion rests upon erro- 
neous notions of the animal economy, and is contradicted 
by ihe discoveries of physiological researches. 

Assalini, in his treatise- on the epidemic fever of Egypt, 
the symptoms of winch were buboes, partial gangrenes, or 
carbuncles, prostration of strength, stupor, head-ache and 
delirium ; a disease generally called the plague, and which 
carried off the patient on the third or fifth day; in treating 
of this disease, he makes the following observations on the 
subject of contagion. u I have seen several individuals con- 
tract the disease and die, although they had been long shut 
up, according to the manner of the Franks. I should have 
thought it right to conclude that the disease of which we are 
now speaking was contagious, had I seen the Egyptians and 
Syrians fall under its influence as well as our soldiers, with 
whom they have constant intercourse. Citizen Larrey, be- 
sides the operations practised in this disease, opened several 
of the dead bodies, and examined with great attention all 
the parts, particularly the buboes, and the state of the lym- 
phetic glands, all of which were, in general, found more or 
less enlarged. Citizen Desgenettes pointed out to me two 
punctures which he had made on himself, while in Syria, 
with a lancet dipt in the pus of a bubo : he made the inoc- 
ulation, persuaded thai the disease was not contagious,* 

* This representation, it would appear, is not quite correct. Desgenettes 
says, that to support the wavering courage of the army, he, in presence of 
the sick, slightly scratched himself in the groin and armpit, but immediate- 
ly washed himself with soap aud water. Dr. M'Gregor informs us that Dr. 
White (ell a sacrifice to the inoculation of himself with pestilential virus, 
(Duncan's Annals of Medicine, Vol. Vlll. p. 264.) And the surgeon Mat- 
thias Dcggio, mentioned by Dr. Guthrie., in his letter to Dr. Duncan, took 



132- Origin, &/c. of Endemic Fever. 

and both these learned and zealous staff officers have con- 
tinued to enjoy good health. The commander in chief, 
Bonaparte, great in every emergency, braved, on several 
occasions, the danger of contagion. I have seen him in the 
hospitals at JaiFa, inspecting the wounds and talking famil- 
iarly with the soldiers attacked by the epidemic and buboes ; 
a conduct which produced the best effect, not only on the 
spirits of the sick, but on the whole army. Among our ope- 
rations in these cases, bleeding required, more than all oth- 
ers, our close approach to the patient and his bed. For my 
part, I followed the common me! hod, without taking any 
precaution, except (hat of avoiding the patients' breath. *Jn 
opening the bubo of an officer, the pus and corrupted blood 
spirted out on the back of my hand. 1 have slept in sheets, 
which without my knowledge had been washed by a female 
patient, who died the day after: sire was the daughter of 
the consul o( Ramli. A young German, the wife of one of 
our soldiers, came to consult me at Use hospital ; during my 
absence she laid herself on my bed for a quarter of an 
hour: I went to visit her the following day, and found her 
expiring.* It is remarked by the same author, that the Be- 
douin Arabs wandering in the deserts, are never attacked 
by the plague, notwithstanding their communication with 
the infected cities, during the times of the most dreadful 
plagues. t 

To the enlightened intrepidity of such intelligent physi- 
cians may be opposed the ignorance and timidity of the an- 
cients, and the error and prejudice of many of the moderns. 
Dr. Falconer, in his essay on the plague, p. 59, cautions at- 
tendants on patients laboring under this disease against com- 
ing in contact with the sick; and when it becomes abso- 
lutely necessary he advises them to protect themselves by 
wearing gloves of oiled silk or linen. He further directs, 
that the spoon with which the patient is fed should not be 

this disease in a mild form by inoculation. I was informed by good author- 
ity that Dr Valli performed this operation on himself, and lost one of his 
great toes in consequence of the successful experiment. From analogy we 
should be ied to conclude that where similar tumors to those in the plague 
make their appearance and proceed to suppuration in the yellow fe\'er, 
disease might be communicated in the same manner. As wdl hereafter be 
made to appear, however, we have reason to brieve that no absorption 
ever takes place from the sound, entire and unabraded surface of the body , 
and it is only when the venerea] matter itself, applied to the most delicate 
parts of the body, excites irritation, that it is absorbed and produces dis- 
ease. In contact with the common integuments, the venereal, as well as 
the pestilential virus, would remain perfectly harmless. 

* Assalini on the Plague, or Epidemic Fever of Egypt, Amer, Edit. p. 17; 

f Ibid, p. 65. 



Origin fyc. of Endemic Fever', 1 3,1 

dipped in a larger portion of food than what is administered 
at a time; and that what he leaves shculd be thrown away. 
That in case of death, precautions must be used with res- 
pect to interments; that the body should be rolled up in 
the under sheet of the bed, and the oiled linen covering un- 
der it. " This would protect the assistant," says he, " from 
the immediate contact of the infected." 

Many physicians of the last century were of opinion that 
intermittents were produced by contagion : among these 
were Boerhaave, Van Swieten, Baglivi, Cleghorn and For- 
dyce ; and if, as already stated, the intermitting is but an 
inferior grade of bilious fever, it must he governed by the 
same laws, both in its origin and mode of communication ; 
if the latter is contagious, the former must be also, but being 
a less malignant form of disease the morbid poison will pos- 
sess less activity and virulence. 

How many instances are there not in the recollection of 
every person conversant with bilious or yellow fever, in 
which the disease has been produced without any commu- 
nication with persons labouring under the disorder? And on 
the contrary, how many are there, in which nurses, friends 
and physicians, whose duty obliged them to be frequently 
in contact with the sick, and yet, notwithstanding this famil- 
iar intercourse, have remained uninfected ? 

So rarely, indeed, has the yellow fever been propagated 
by contagion, that most of those who have been conversant 
with the disease, deny its ever being communicated in this 
manner. 

Dr. Robert Jackson, speaking of the cause and nature of 
endemic fever in the West Indies, as originating from a ve- 
gito-animai source of materials, in contradistinction to that 
arising from an animal source, or an altered condition of the 
living human body, which he considers contagious, remarks 
that this cause " often rapidly destroys life ; but it begets 
no process in the human system, by which it propagates it- 
self. In short, endemic fever may be, and often is, epidem- 
ic; but it is not contagious, the individual requiring, in all 
cases, to be approached to the original source, before infec- 
tion. As the sources of endemic fever are common to the 
surface of the globe, had the diseases arising from these 
sources been capable of multiplying causes, endued with 
the quality of producing similar diseases, the world must 
soon have become an hospital or a desert.*'* 



Outline of the History and Cure of Fever, p. 108- 



334 Origin, fyc. of Endemic Fever, 

" I have had no occasion to observe," says Dr. Hunter, 
" that the remittent fever, whether with its usual or more 
uncommon symptoms, with the yellow colour of the eyes 
and skin, or without them, was ever found to be infectious." 
He says the inhabitants have no fear of the fever being in- 
fectious, nor did he ever find reason for supposing it to be so 
either in private families or in military hospitals. And ju- 
diciously observes that the operation of a cause generally 
diffused, is often confounded with the eifects of infection.* 

Dr. Ramsay, in his History of South Carolina, observes, 
that the laws of Carolina, guard against the yellow fever, 
as an imported contagious disease ; but, that the uniform 
experience of the physicians in Charleston, Since the year 
1732, proves that it is neither the one nor the other; ki for. 
in no instance (he remarks,) has a physician, nurse, or other 
attendant on a person, labouring under this disease, caught 
it from them. Several after taking it in Charleston, carried 
it with them, and died in the country ; yet it never spread, 
nor was communicated to anyone who attended them." — 
In a letter to Dr. Miller, dated, Nov. 18, 1800, on the same 
subject, he observes, ''the disputes about the yellow fever, 
which have originated in the northern states, have never ex- 
isted in Charleston. There is but one opinion among the 
physicians and inhabitants ; and that is, that the disease was 
neither imported nor contagious. This was the unanimous 
sentiment of the Medical Society, who, in pursuance of it-, 
gave their opinion to the government last summer, that the 
rigid enforcement of the quarantine laws, was by no means 
necessary on account of the yellow fever."t 

It is stated on the authority of Dr. Mease, % that whilst he 
resided at the lazaretto, as inspector of sickly vessels, be- 
tween May, 1 794, and the same month in 1 793, the clothing 
contained in the chests and trunks of ail the seamen and 
others, belonging to Philadelphia, who had died of the yel- 
low fever in the West Indies, or on their passage home, and 
the linen of all the persons who had been sent from the city 
to the lazaretto with that disease, amounting in all to more 
than one hundred, were opened, exposed to the air, and 
washed by the family of the steward of the hospital, and 
yet no one of them contracted the least indisposition from 
them. 

Dr. M'Lean, in his Inquiry into the Nature and Causes 
of the Great Mortality, in St. Domingo, pages 78 and 79, ob* 

* Observations on the Dis. of the Army in Jamaica, p, 178-9. 

1 Med. Repos. Vo. 4, p. 218. 

i Rush's Inq. and Obs. Vo. 4, p. 241. 



Origin, #-c. of Endemic Fever, 135 

serves that the medical gentlemen could not have possibly 
escaped, if there had been any infection : nor could we re- 
mark, in any instance, that the immediate attendants of the 
sick suffered more than others. Dr. Wright, Dr. Gordon, 
and Dr. Scott, he says, agreed with him, in its not being con- 
tagious ; " in short," continued he, " I never conversed with 
any medical gentleman in St. Domingo, who did not form 
the same judgment." 

Dr. Wade has published a paper on the disorders of sea- 
men and soldiers in Bengal, in the Medical Commentaries, 
wherein he observes, that during his residence in Bengal, 
fevers and dysenteries were often epidemical, but that they 
never exhibited any appearance to his faculties, which could 
excite a suspicion of contagion.* 

Dr. Henderson published a treatise on the prevention of 
yellow fever, of 114 pages ; from which it appears that all 
the observations he could make on the causes and progress 
of yellow fever militate against the opinion of its being con- 
tagious. 

Mr. Thomas Clarke, in his observations on the Nature 
and Cure of Fevers, and of the diseases of the East and 
West Indies, &c. p. 110, remarks, that fevers in all climates, 
depend very much upon the state of the surrounding atmos- 
phere, and that they are uot at all contagious; or at least, 
that they are communicated in a very different manner from 
the small pox or measles. 

It is stated by Dr. Catlett, that in the yellow fever which 
originated on board the Ganges, while in the West Indies, 
he discovered no instance of personal contagion. f 

Dr. Hillary, on the yellow fever of the West Indies, 
says, " this fever is rarely or never infectious or contagious 
to others ; I never could observe any instance, where I 
could say that any person was infected by it, neither have 
I ever seen two people sick in this fever, in the same house, 
at or near the same time, unless they were brought into the 
same house, when they had the fever upon them. "J 

Palloni, on the yellow fever of Leghorn, observes that 
among so many priests as daily attended on the sick, there 
was but a single one attacked and destroyed by the disease ; 
not one of the assistants in the hospital experienced its ef- 
fects ; and only two or three professors of the healing art, 
who were surrounded by the sick almost constantly for a 

* Medical Commentaries, Vo. 16, p. 200. 

t Med. Repos. Vo. 4, p. 244. 

t Hillary, on the Air and Diseases of Barbadoes, p. 146. 



131) Origin, fyc, of Endemic Fever. 

great length of time, inhaled the infection; "with the ex- 
ception of two or three streets in Leghorn." says Palioni, 
" where the disease seemed to have fixed its seat, few other - 
parts were attacked by it for a moment, and not even then 
if they were more than the smallest distance removed, al- 
though a great number of persons, and vast quantities of 
merchandize were moved from the points where the disease 
raged, and daily transported and dispersed into the neigh- 
bouring country. To this there were few exceptions, and 
in those cases, the disease ended in the very houses where 
it broke out/' This, for an advocate of contagion and im- 
portation, hke Palioni, is saying a great deal. In a letter 
from a gentieman in Leghorn, dated December 22d, 1824, 
are the following observations upon the same subject. — 
" There was something mysterious in the nature of this fe- 
ver — for (hough we have no doubt of its being imported, yet 
we observed in the hospitals, where the sick were convey- 
ed, not a single person, out of one hundred who attended 
them in different capacities, was infected — nor did any of 
the men, amounting to between three and four h mdred, 
who carried the dead to their graves, take the disease. It 
raged from the 15th of August to the 20th of October ; du- 
ring which time, there died about seven hundred per- 
sons." 

Dr. Chisholm, as well as some physicians of our own 
country, have laboured hard to convince their obstinate 
brethren of the healing art and mankind generally, in oppo- 
sition to their sober reason, that the yellow fever of Phila- 
delphia, of 1793-4-5 and 97 was imported into the United 
States, from the island of Granada : to which it is said to 
have been previously introduced from Boulam, whereas it 
appears from the journal of Thomas Story, and from John 
Gaugh's History of the Friends, that (he yellow fever pre- 
vailed in Philadelphia as early as 1699; from Hewitt's His- 
tory of South Carolina, we also learn that many persons 
were destroyed by it in Charleston the same year ; accord- 
ing to the same author, it appeared a second time in the 
same city, in 1703, and again in 1728, 1739, 1740, 1748 and 
1761. 

The yellow fever was epidemic in Albany in 1748; in 
Virginia, in the years 1737 and 1741. A similar disease at- 
tacked the Indians in Nantucket, in the summer of 1763: 
of which, out of 258 who were attacked, 36 only recover- 
ed. The same disorder prevailed in Philadelphia, in 1778, 
during the summer and autumn succeeding the evacuation of 



Origin, fyc. of Endemic Fever, 1ST 

the city by the British. This fever prevailed in New- York, 
in J 791, and in numerous other places, at a date anterior 
to the pretended importation from Granada. Dr. Chisholm, 
in his letter to Dr. Haygartb, has laboured this subject 
with his usual zeal ; but his arguments are far fetched ; and 
his conclusions erroneous. Since, however, it has been a 
matter of much discussion, it will be proper to give it a 
transient examination, in order to see whether the doctrine 
of importation is supported by facts and probability. " I am 
convinced," says Dr. Chisholm, u and most of the West 
Indian and North American physicians are also, that the 
same virus which gave birth to the malignant pestilential fe- 
ver of Granada, was also the parent of that of Philadelphia 
of 1793, by means of the trading vessels constantly passing 
between these piaces. Dr. Pinkard says " when Europeans 
fir?t take up their residence in the West Indies, it is usual 
for them, sooner or later after their arrival, to undergo an 
attack of fever, which in times of peace and tranquillity, 
when, as they are called, the nvzv comers are but few, is term- 
ed a seasoning fever ; but in times of war, when, from great 
multitudes arriving at the same period, its destructive effects 
"are more striking, it is baptized with the terrific name ofye/- 
lorc fever ; but whether denominated seasoning, Bulam or 
&wm, or marked by any other appellation, it is only the 
common bilious fever of hot climates ; and it appears under 
an intermittent, a remittent, or a continued form, according 
to the soil and situation of the place ; or the habit of body, 
and other circumstances of the persons attacked." " This," 
says Dr. Chisholm, who makes use of this quotation, " is 
precisely and truly applicable to the yellow remittent fever ; 
but in relation to the malignant pestilential fever of 1793- 
94-95 and 96, it is absolutely irrelevant and untrue — The 
result of a very attentive consideration of the ship Hankey, 
as they are (it is) represented to me," continues our author, 
" on the arrival of the ship at Granada, I have already stated 
to be, that a (ever, proceeding originally, perhaps, from 
the inclemency of the season, and the circumstances of the 
situation of the adventurers, had become, by confinement, 
filth, consequent impurity of the air, and depression of spi- 
rits, a irue jail fever, or a fever of infection, heightened to 
an almost pestilential virulence." In page 95 he adds, " in 
this ship, (the Hankey,) are to be found the remote causes 
of this dreadful fever which devastated the West India isl- 
ands, the British Army and Navy, the principal cities ancL 



138 Origin, $rc. of Endemic Fever '. 

towns of North America, and some of the more populous 
sea-ports and towns of Spain and Europe."* 

Such is the sweeping asseveration of Dr. Chisholm ; as 
remote from truth and probability, as we are from the anti- 
podes. It is to the infection generated on board this vessel, 
the Hankey, that, according to Dr. Chisholm, and the other 
physicians of the West Indies, and the United States, of 
whom he speaks, we are to trace the bilious or yellow fever, 
which has committed such ravages among the human race 
in the West Indies, North America, and in the different 
towns and sea ports in Europe; whereas, it appears from 
what was above stated, page 36, that this disease had pre- 
vailed in the United States, at different places, long before 
the time of Dr. Chisholm, and his ship Hankey; and, Dr. 
Hillary, as well as other West India writers, have described 
the same disease as existing in the West Indies, many y-ars 
anterior to the time alluded to by Dr. Chisholm. Can it 
indeed, be reasonably supposed, that a little stinking vessel, 
like Pandora's box, should scatter the seeds of pestilence 
and death throughout the earth ? Or, was the jail fever, as 
Dr. Chisholm represents this disease to be, which was gen- 
erated on board the Hankey, ever known to become epi- 
demical ? Never : but even admitting the possibility, the 
jail fever, is the jail fever in every part of the world ; and to 
suppose it capable of being extensively diffused in the 
character of an epidemic, presupposes the possibility and 
danger, that every case of typhus which originates in a fil- 
thy hovel, may form the germ of a pestilential disorder* 

Dr. Chisholm, with the dictatorial arrogance of superior 
sagacity, has implicitly asserted, (hat the bilious yellcw fe- 
ver, which prevailed in Philadelphia, in 1793-4-5 and 6, 
and which is so well and accurately described by Dr. Rush, 
was in fact the jail fever, generated onboard the vessel 
above mentioned, and from her propagated and diffused 
over the surface of the globe. And are the physicians of 
the United States such novices in their profession, as not to 
be able todistinguish the jail, from the bilious fever? Need 
they the instructions of Dr. Chisholm, to form their opinions 
and direct their judgment ? If men will permit themselves 
to be guided by the leading strings of infancy, they must ex- 
pect to he fed with the pap of childhood. 

From the concurring circumstances, we are not surprised 
that t)phus fever should have been generated on board the 
Hankey. The same thing would have happened in the 

* Chisholm on the Malig. Pestilent. Fev. p. 93. 



Origin, &c. of Endemic Fever, i39 

West Indies, under the same circumstances, and has hap- 
pened in a thousand instances in other places ; yet, who 
would have the weakness and credulity to trace a prevailing 
epidemic to the offensive colluvies of a ship ? We are told 
by Dr. Chisholm, that this was no doubt a ship fever, as it 
was generated on board the Hankey, at the time she lay at 
pujam, from the crowded state of the vessel, want of clean- 
liness, heat of climate and a rainy season. And that it was 
not generated on shore, he informs us that Bulam, being 
surrounded by the sea, enjoys all the advantages of the sea 
breeze ; and being dry, and not incommoded by any marshy 
tracts, it is considered as the healthiest spot on the wind- 
ward coast, and that it is not inhabited.* In page 86 of the 
same letter, he mentions the circumstances of the vessel it- 
self as favouring the production of this jail or ship fever, 
" having upwards of two hundred people*" says he, u of 
whom, women and children constituted a part,thus confined 
in a sultry, moist atmosphere, cleanliness could not well be 
attended to, however well inclined the people themselves 
might be. And no doubt can be entertained, that neglect- 
ing to sweeten the ship, to ventilate her afterwards, and to 
destroy the clothes? bedding, &c. of those who died on 
board, was the sole cause of her retaining the seeds of in* 
fection when she arrived in port." In page 1 14, he describes 
the particular features of distinction between this disease 
and the typhus icterodes, as he is pleased to style the yellow 
fever, 4 * A principal distinction," says he, "between this 
disease and the typhus icterodes, is the yellow suffusion, 
which in the former very seldom happens, in the latter al- 
most always." " On the other hand," he adds, tk the appear- 
ance which marked the character of the fever most une* 
quivocally, was a species of efflorescence, which is said to 
be peculiar to malignant and pestilential fevers ; this efflo- 
rescence resembles more patches of red and livid spots, than 
what is generally understood by the word petechia^ and ap- 
peared sometimes at the commencement of the low or com- 
atose state ; but, often a few hours before death, it was a ve* 
ry fatal symptom. The neck, shoulders and breast, were 
generally the parts of the body the eruption broke out onj 
but, in a few very violent cases, almost the whole body has 
become a deep livid or black colour, three hours before 
death. 



* See Chisholm's letter to Haygarth, "in order to correct the pernicious 
doctrine promulgated by Dr. Edward Miller, and other American Physi- 
sdans, relative to Pestilential Fever." Loud. 1809, p. 84* 



14© Origin, fyc. of Endemic Fever* 

It is strange that such avowed defenders of the specific 
nature of fevers, as Dr. Chishoim and his associates in opin- 
ion are. should, in the present instance before us, recede 
so far from their principle, as to acknowledge the identity 
of diseases, which, according to their own doctrine, dif- 
fer so essentially in their nature and symptoms', I have 
seen a disease, similar to the one described by Dr. Chis- 
holm, as prevailing on bocrd the Hankey, generated on 
board the United States brig Louisiana, at Flaquemine ;* 
but as different from the bilious remittent fever of Philadel- 
phia, in its symptoms, as is the small pox from the measles. 
And the fever which prevailed in Philadelphia, in 1793. is 
too well described by Dr. Rush, to admit of being con- 
founded with the jail or ship fever of the Hankey. It 
appears that none of the men, who were sent on board 
this vessel, received the infection ; nor did fever appear in 
any of the ships of war, which lent her assistance, in con- 
sequence of this communication. This subject is taken up 
by Dr. Trotter.f who considers it probable from these facts, 
that the Hankey did not import the infection that produced 
the Granada fever, "for after the disease was worn out," 
says he, " she had a passage to make to the West Indies, of 
many hundred leagues. It is also doubtful how the effects 
left in the Hankey could produce the k-xcr, for the bed- 
ding was thrown away, and what clothing remained, had 
been aired, and probably, had scarcely been in contact 
with the body after being sick. Mr. Smithers, surgeon, who 
went on board the Hankey. while on her passage to the 
West Indies, was examined before the Governor of Grana- 
da on the subject, and gave his opinion, decidedly, that the 
Hankey did not communicate this fever to the colony ; from 
our people remaining some days on board, at sea, and es- 
caping with impunity, is a strong support to the evidence of 
Mr. Smithers. Dr. Chishoim has laboured his arguments 
to prove, that it was a new disease ; though perhaps, only 
the common endemic of the country, more aggravated by 
a greater number of Europeans being the subjects of its in- 
fluence, than he had been accustomed to observe before." 
It even appears that Dr. Chishoim has given an exaggerat- 
ed account of the endemic of Granada. Lieut. Governor 
Young, in his Return of the Bulama Adventurers, speaks of 
the fever as being of the intermittent kind, and not infectious. 



* See account of this Disease, in Observations en the Topography a?i4- 
Diseases of Louisiana. 
tMedecinaNautica, Vo. l,p. 331. 



Origin, fyc. of Endemic Fever, 141 

while the mortality is ascribed by Mr. Paiba, to various cau- 
ses., some having intermittent?, some more violent fevers, 
some diarrhoea, others dysentery, and others again fell mar- 
tyrs to the indiscreet use of opium, and spirits, which they 
took as preservatives.* 

It appears, moreover, that the ship Hankey did not airive 
at St. George, in the island of Granada, till the 19th of 
March, whereas we are informed by Mi:. Paiba, that the fe- 
ver prevailed in Granada, as early as the 1st of the same 
month, and Dr. Chishohn himself observes, that " from the 
beginning of March, to the first of May, 200 out of 500 
sailors, who manned the ships in the regular trade, died of 
this fever." The sickness and mortality which prevailed in 
the town of St. George, in the Island of Granada, is abun- 
dantly account for, by a reference to local causes, without 
bringing in the aid of importation. 

The town where Dr. Chisholm's malignant pestilential fe- 
ver raged, in 1793, is situated on a narrow strip of land, 
bounded on the one side by the bay of the same name, and 
on the other by the Careenage. The Careenage is a long 
inlet or arm of the sea, running up on the south and east 
side of the town of St. George. It is low, little moved by 
winds, and nearly stagnant, as the river never rises or falls 
there, more than four, five, or six inches. The shore of the 
Careenage, on the town side, is remarkably low, narrow, 
and crowded by numerous little buildings, chiefly of wood, 
which are separated only by lanes, situated on, or near the 
wharves, and inhabited by the lowest of the people, ill-ac- 
commodated, and devoted to intoxication and every species 
of debauchery. At the head, or east end of the Careenage, 
is a large marsh; which, at ail times, but especially at low 
water, sends forth the most noisome and offensive smell. — 
Into this inlet, vessels are general brought to refit and ca- 
reen, and indeed for protection, as they are perfectly safe 
from the winds. At the time of the Hankey's arrival, it 
appears to have been unusually crowded with shipping ; 
and that ship was brought round from the Bay, into the Ca- 
reenage, very soon after she reached Granada. t Now, if in 
addition to all this, we take into consideration the geograph- 
ical position of this island, in the 1 2th° North latitude, under 
a vertical sun beaming upon a mass of corruptible materials, 
we can be at no loss, as to the origin of a disease of unusual 
malignancy, or to account for the mortality which took place 

*Edinb. Med. and Surg. Journal, Vo. 0, p. 341. 
t Med. Repos. Vo. ) , p. 459 aud seq. 



142 Origin, ire, of Endemic Fever, 

among Europeans lately arrived. We further learn, that 
in different places, the disease assumed different aspects of 
seventy or mildness, according as particular parts of the isl- 
and were more or less marshy and low, or elevated and dry. 
Notwithstanding all his endeavours to trace a foreign deri- 
vation, Dr. Chisholm describes a similar fever which pre- 
vailed in the Island of Granada, in 1791, and which he ac- 
knowledges to have been of local origin.* But because the 
ship Hankey had been upon the coast of Africa, in 1793, 
where she had engendered disease, and subsequently arrived 
at the island of Granada, a place more unhealthy from local 
causes and situation, than Bulam itself, he vainly endeav- 
ours to trace the fever to a foreign origin ; though the Han- 
key, previously to her arrival at Granada, was thoroughly 
purified, and had for many weeks been free from infection and 
disease. We are informed by Dr. Le Blond, in his Essay on 
the Yellow Fever, that as long ago as 1770, the Careenage 
was a sickly place. The yellow fever was frequent, and par- 
ticularly fatal to strangers. Its malignity was dreadful, in 
consequence of the unhealthy exhalations from the marsh, 
near the port and town of St. George. Dr. Le Blond, 
practised there two years. There were, then, local causes 
enough for the disease, and the importation from Bulam 
had not been thought of. 

For misrepresentation of facts by Dr. Chisholm, respect- 
ing the origin and propagation of the yellow fever in the 
island of St. Thomas, I refer the reader to the statement of 
Mr. Eckard, Danish Vice Consul, in the Medical Reposi- 
tory, second Hexade, volume 1, page 336. 

Dr. Chisholm, with much gravity and form, endeavours 
to point out the distinction, between the plague and malig- 
iiant pestilential yellow fever, and thinks that he has settled 
the difference in the following manner. "First, the differ- 
ence between the plague and malignant pestilential fever, 
appears chiefly in the mode of communicating the conta- 
gion, in the plague, Dr. McGregor thus states it " but ex- 
cept from actual contact, there never appeared to be any 
danger." It is, therefore, and the fact is further confirmed 
by some observations of Dr. Russel, pretty evident, that 
contact is necessary to produce the disease. In the malig- 
nant pestilential fever, around the diseased person, there is 
an infectious atmosphere of a determinate radius, within 
which the disease may be communicated : in it contact is 



*Edinb. Med. Comment for 17&3. 



Origin, &c» of Endemic Fever. 14$ 

not a necefesary condition : Secondly, a second distinction 
is perceived in the atmospheric temperature necessary to 
give prevalence to each disease respectively. This is a very 
curious circumstance, and certainly, in many respects, a 
verv important one ; the contagion of plague can be prev- 
alent, only in a temperature between 40° and 80°, a tempera- 
ture above or below these degrees extinguishes it ; the con- 
tagion of the malignant pestilential fever becomes preva- 
lent only in a temperature between 70 and 90 degrees ; 
but it is extinguished or suspended in a higher, and probably 
cannot exist in a much lower.* 

This distinction, which the Doctor endeavours to estab- 
lish, if rightly understood, is no distinction at all* In 
the first place, as to contact being necessary to produce the 
one arid not the other ; it is proper to understand, that a gen- 
eral disease is never communicated by primary action on 
the surface of the body ; as it will be hereafter shown, that 
no cuticular absorption ever takes place, and without such 
absorption, we are unable to account for the production of 
disease in this manner ; since the cuticle is destitute of 
nerves and blood vessels, and therefore insensible to impres- 
sions calculated to affect the vascular and nervous systems. 
As to the second distinction, that plague can only be prev- 
alent at a temperature between 40° and 80°, is allowing al- 
most all possible variation from the heat of summer to the cold 
of winter ; and as plague, if it prevails at all, must appear 
in one of the seasons embraced between the ranges of this 
temperature, it is no more or less than saying, that this dis- 
ease must become prevalent in one or other of the four di- 
visions and seasons of the year ; the truth of which was suf- 
ficiently known, before the profound discovery of Dr. Chis- 
holm. 

As Dr. Chisholm does not stand so high as to give his as- 
sertions the weight and implicit evidence of oracles, he 
should have adduced authority to show that a temperature 
above 80 degrees of Fahrenheit, extinguishes the plague, or 
that a degree of heat above 90, puts a stop to the malignant 
pestilential fever, if by this denomination he designates the 
bilious yellow fever of the United States ; if so, his posi- 
tion is untenable, for this disease has prevailed in various 
places, where the temperature in the sun was as high as 1 1 5 
of Fahrenheit. He was however tolerably safe in limiting 
the degree to 90, as the natural temperature of the atmos- 
phere, in the shade, seidom exceeds, or even reaches that 

* Chisholm's Letter to Haygarth, p. 155-6 and 7. 



144 



Origin, fyc. of Endemic Fever. 



in the hottest latitudes. It is well known that a high 
temperature is necessary to the origin of all fevers of an 
endemic character, and no less so in the piague than in fe- 
vers of inferior malignancy. It is not, however, at the same 
time denied that diseases of a very malignant character, and 
such as have received the name of plague, have prevailed 
during the winter season, and under a low temperature of 
the air: but, as (he term plague has heen extremely vague 
and indefinite in its application, there is no doubt that dis- 
eases of a very different character have been baptised with 
this appellation, as a generic term, for all malignant disor- 
ders with which physicians were unacquainted. Thus, the 
term cold plague, winter fever, spotted fever, pneumonia ty~ 
phoides. &c. have all been given by different persons to the 
winter epidemic of the United States, which, however, dif- 
fers very materially in its causes, from the endemic bilious 
yellow fever or the plague of hot climates, arising from heat, 
moisture and putrefaction. 

Dr. Chisholm wishes to establish the peculiar and specific 
character, of what he calls the malignant pestilential fever, 
which he says originated on board the Hankey, and was a 
true jail fever, afterwards propagated into various parts of 
Europe and America. Had not this opinion been embrac- 
ed by some respectable gentlemen of the profession, in our 
own country, as well as in Europe, I should have consider- 
ed it too weak and unsubstantial to deserve a moment's con- 
sideration^ but, as the removal of error, is no less important, 
than the advancement of truth, I have bestowed the more 
pains on this subject, than its merits might intrinsically seem 
to require. 

In the distinction attempted to be established, by Dr. 
Chisholm, we are informed that the yellow fever is not con* 
tagious, and that the malignant pestilential fever is contagious; 
and, although he had never been an eye witness of the fever 
of any of our seaports, and with very little experience in the 
West Indies, he has the confidence to assert, that the fever 
which prevailed in Philadelphia, in 1793. and in subsequent 
years, as also in different parts of the United States, was the 
malignant pestilential fever, and not the yellow fever, as 
represented by Dr. Rush, Dr. Miller and others. But. to 
follow Dr. Chisholm, any further in his speculations, would 
be. to forsake the substance, in pursuit of a shadow. 

Dr. Pinkard, who practised in the West Indies, where he 
had frequent opportunities of observing the endemic fever 
of the climate, after affirming the identity of the disease, 
known by the distinctive appellations of yellow fever, sea- 



Origin, fyc. of Endemic Fever: 14a 

soning, Bularn, &c. and ascribing their diversity of aspect 
to the soil, situation and circumstances of the person at- 
tacked, he continues, " in negroes and Creoles it is fre- 
quently an ague, in those who are in a degree acclimated 
a remittent, and in new corners a continued fever; preserv- 
ing in each case a distinct type throughout its course, while 
in other instances of its attack upon Europeans it shifts its 
form and runs its progress with the most uncertain irregu- 
larity ; in proof of which I may remark, that I have receiv- 
ed newly arrived soldiers into the hospital, at one and the 
same time, with the seasoning malady, under all the vari- 
eties of an intermittent, remittent and continued (e\er, and 
although each had been differently attacked, all of them have 
died in the course of only a few days, with every symptom 
of the most malignant yellow fever." On the subject of 
contagion, he observes " of all the multitudes of black men 
and women, whom I have had occasion to see employed 
constantly in the hospital, and who have exercised all the 
menial duties about the sick, the dying and the dead, I 
never yet knew a single instance of any one of them, either 
male or female, taking the disease. " 

In a letter from Dr. Senter of Newport, dated January 
7th, 1794, is the following fact, in support t>f the principle 
that the yellow fever does not spread by contagion, or pro- 
pagate itself by imported fomites. " This place," (New- 
port, R. I.) says the Doctor, " has traded formerly, very 
much to the West India islands, and more or less of our peo- 
ple have died there every season, when the disease prevails 
in those parts ; clothes of these unfortunate people have 
been repeatedly brought home to their friends, without any 
accident happening to them.'' 

If such is the difficulty attending the propagation of yel- 
low fever, it may be asked, wherein consist the use and 
necessity of quarantines ?* Not as a means of preventing 
the importation of the plague oryellow fever, which, as ep- 
idemics, never can originate from contagion ; but the sole 
utility of this practice, founded as it is upon erroneous 
principles, consists in making captains and masters of vessels 
attentive to the cleanliness of their crews and of the vessels 
under their command : the fevers which often commit such 
destruction on ship-board are of local origin; quarantine regu- 
lations are founded on the presumption that they are exot- 
ics and of foreign growth. The captain of the infected 



* See the Questions proposed by the Government of the Buchy of Olden* 
burs:. 



14b Origin, ^c. of Endemic Fever. 

Vessel knows to the reverse, and as by care and cleanli- 
ness he has it in his power to prevent this inbred pesti- 
lence ; the expense and delay attending the quarantine of 
an infected vessel, might have an influence in making him 
attentive to the health of his crew. It is conceived, that 
this is the only benefit attending the practice of quarantine. 
But it is still a matter of doubt, whether this consideration 
would operate more powerfully in the preservation of cleanli- 
ness, than that of private interest, safety and advantage, in- 
dependent of all laws and quarantine regulations. Against 
the practice of quarantine, several objections may be urg- 
ed ; and one of the most considerable and weighty is, that 
by directing the attention of the police of cities and sea- 
ports from domestic nuisances to the importation of a for- 
eign foe, cleanliness and the means of self preservation 
are neglected at home; and thus the disease, arrayed in all its 
terrors, arises in ambush, from the fostering indulgence of 
ignorance, blindness and neglect. 

The evidence in proof of importation is, at best, equivo- 
cal. All that can be advanced in its support is, that previ- 
ous to, or during the prevalence of the yellow fever at a 
particular city, a vessel or person arrived from an infected 
port; whereas, had the same vessel or person arrived at any 
other time no notice would have been taken of the circum- 
stance. As such arrivals, however, in large sea-ports, take 
place every week, there is less difficulty in tracing the im- 
portation, than in accounting, upon the principles of the con- 
tagionists, for the general exemption from disease. But, in 
support of the position that the yellow or endemic fever of 
hot climates arises from local causes the proofs are nume- 
rous and conclusive; and when principles are established by 
facts and philosophy, speculation and error should yield their 
pretensions. 

Dr. Ffirth, speaking of the fever of Batavia, says, "the 
disease is certainly local, being engendered by the causes 
already mentioned, (see page 63.) and is never contagious. 
The people here, have no idea of the fever being spread or 
communicated by contagion ; yet, if the fever was to pre- 
vail in the sea-ports of the United States, it would be call- 
ed malignant fever, and said to be very contagious. It 
shows many of the symptoms of the yellow fever of Ameri- 
ca, and perhaps the only reason they are not exactly alike, 
is, the difference of climate, &c. for it is equally, yea, more 
malignant in many cases. In Batavia, every person savs it 
is not contagious ; in America, a disease nearly similar, if 
not the same, is^said, by many, to be decidedly contagious. 



Origin, <^c. of Endemic FevcK 14.? 

and imported. If it is not contagious in Batavia, can it be 
so in America? If it arises from local causes in the one 
place, why not in the other? The laws of nature are im- 
mutable, they are alike in every situation. If the disease 
is not contagious, and arises from local causes in one coun^ 
try, or one part of the world, it must in every part in which 
it prevails ; if certain circumstances will produce it in one 
place, they will in any place, in every place, no matter, 
whether in the torrid or the temperate zone." 

Such are the opinions of those physicians who have been 
most conversant with the yellow or endemic fever of hot 
climates, in relation to the subject of the contagion and origin 
of this disease. Many more illustrations might be brought 
forward in relation to this branch of the inquiry, but it is 
considered that the foregoing are sufficient. In order to 
give them the more weight and authenticity, I have fre- 
quently stated the facts in the author's own words ; a prac- 
tice which the mere historian is not compelled to observe* 
Where the references were preserved, I have generally 
stated them , with a view of affording facility to the inquiries 
of others who may feel an interest in examining the sub? 
ject matter of investigation. 



fl48 Predisposing and Exciting Causes.. 

OF THE 

PREDISPOSING and EXCITING CAUSES 

OP 

ENDEMIC FEVER. 



CHAPTER III. 



Whatever has a tendency to impair the usual strength 
and vigor of the hody, may be considered as acting as the 
predisposing cause of fever; as fatigue, however induced, 
severe labor, excessive exercise, exposure to a high tem- 
perature, poverty of diet, strong passions, fear, grief, anxi- 
ety, disappointment, habitual or occasional melancholy, vi- 
olent purges, suppressed evacuations, repelled eruptions. 
It is at the same time difficult to draw the line of distinction 
between what are commonly called the predisposing and 
the exciting causes; since it frequently happens that the 
same agent acts both as the predisposing and the exciting 
cause of fever. A more proper distinction will probably 
be found in considering miasma or infection as the predis- 
posing, and all other sudden, violent and debilitating im- 
pressions as exciting causes. In this way we may presume 
that during the prevalence of endemic fever, persons expo- 
sed to the noxious miasmata are in a constant state of pre- 
disposition, from the circumstance of their being continual- 
ly imbued with the febrile infection, which requires only the 
weak and unguarded state of the system, produced by any 
irregularity, excess or fatigue, to excite it into action. At 
other times the body may be so strongly impregnated with 
the materials of disease as to require no particular exciting 
cause, other than the infectious matters already present ; 
the miasma or infection thus acting both as the predisposing 
and exciting cause. 

In a state of predisposition, a slight cause is sufficient to 
destroy the balance of the system, and to turn the scale i» 



Predisposing and Exciting Causes. 1 40 

favor of disease. Thus a strong cathartic, a fit of intoxica- 
tion, the sedative passions, fear, grief, despondency, de- 
pression, melancholy and despair — late watching — exces- 
sive venery — fatigue — a hearty meal — indigestible food — a 
free indulgence of viands, beef, pork, fish, fowl, &c. — cu- 
cumbers, muskmelons, unripe fruit — exposure to the night 
air — wet feet — wet clothes — the excessive use of cold bath- 
ing — too sparing a diet— inactivity of body, &c. 

The circumstance of the body itself affording the strong- 
est and most susceptible predisposition is a constitution un- 
accustomed to the climate ; to which may be added a scor- 
butic habit. Upon some of these causes it will be proper 
to make a few remarks. 

It has been universally observed that persons removing 
from a healthy, to a low, swampy arrd unhealthy coun- 
try, are the first and greatest sufferers by the fever. This 
circumstance is annually exemplified in those who mi- 
grate from the northern to the southern states : and has 
been more abundantly demonstrated in the West Indies, 
where the greatest proportion of troops that are sent to that 
country die the first year with the endemic fever. To these 
islands disease is a stronger safeguard than all the fortifica- 
tions that could be raised by the art of man. Where death 
has been anticipated in a single instance by the implements 
of war, thousands have fallen victims to the destroying pes- 
tilence. 

Dr. Hunter, in his Observations on the Diseases of the 
Army in Jamaica, states, that of the negroes sent along with 
the troops against Fort St. James, scarcely any died, al- 
though i'ew or none of the soldiers survived the expedi- 
tion.* As a constitution unaccustomed to morbific mias- 
mata is in a peculiar manner liable to be affected by ex- 
posure to uuwholesome exhalations, so, on the other hand, 
a constitution inured by custom to their presence is one 
of the best securities against their injurious operation. — 
Hence persons coming from the West Indies, even to an 
unhealthy part of the United States, are, in a great measure, 
secure against any prevailing febrile epidemic. To this 
purpose we are informed by Dr. Rush, that in the year 1793 
a body of emigrants from St. Domingo, amounting to up- 
wards of three bundled in number, who had made their es- 
cape from that colony, under all the circumstances of the 
most afflicting depression, arrived in Philadelphia, at the 
time when the yellow fever raged with the utmost malig- 

» Diseases of Jamaica, p. 25. 



ioO Predisposing and Exciting Causes. 

nancy; yet not one of the ir> was attacked with the destruc- 
tive malady which was then desolating that city. And (he 
fact is rendered the more striking from the circumstance that 
the emigrants who arrived at the same period from Ireland, 
Germany and other parts of Europe, were attacked by the 
fever, even in greater proportion than the Americans them- 
selves. The same thing has been observed in different parts 
of Alabama, during the prevalence of endemic fever in sum- 
mer and autumn. Persons from the unhealthy parts of the 
Carolinas and Georgia are much less subject to the endem- 
ic fever than those from Tennessee, Kentucky and the nor- 
thern states. Among emigrants from the latter places, the 
disease is more frequent and violent; often assuming the 
most aggravated symptoms of the yellow fever. Persons 
from northern cities and sea-ports are also less liable to fe- 
ver than those from more healthy and inland situations. A 
long familiarity with and exposure to noxious agents con- 
stantly and uniformly acting, at length fortify and secure 
the constitution, in a great degree, against their injurious 
tendency. Thus persons who have passed a seasoning in 
the East or West Indies, are seldom afterwards attacked 
with the endemic of the climate. Not so, however, in the 
middle and southern states of North America. No country 
in the world is more healthy than the southern section of the 
United States during the winter season. It is from this ex- 
emption from the causes of disease during this period, that 
the constitution is again rendered susceptible to their opera- 
tion on the approach of the ensuing season : the cold and 
healthfulness of winter imparting to the system, in a consid- 
erable degree, the sensibility of northern and European con- 
stitutions to morbid impressions. Thus it is that natives 
and old residents in the country not unfrequently suifer and 
die with the common endemic of the climate ; though in a 
much less degree than strangers from the northern states, 
and the hilly and healthy parts of Tennessee and Kentucky. 
It was observed by Dr. E. H. Smith, in the bilious or yel- 
low fever of New- York in 1795, that few persons died who 
had regularly resided in a low, sunken part of the city, (for- 
merly called the swamp,) but that to those whose evil des- 
tiny led them to seek a new dwelling place there, it proved 
highly pestilential.* V\ T e are further informed that in the 
same epidemic, the greater number of those who sickened 
and died of that disease were foreigners ; persons either just 

* See the letter of E. IT. Smith, an ingenious physician of New- York, to 
Dr. W. Buel of Sheffield, Mass. in Webster's Collection of Papers or> Bil- 
ious Fevers^ p. 79. 



Predisposing and Exciting &auses\ 1^1 

arrived from other states, from the West Indies and from 
Europe, or who had not long been settled in the city; and 
that the probable proportion of citizens to strangers who 
died, did not exceed one to seven. * 

Dr. Le Blond, t in his Observations on Yellow Fever, 
speaking of the exemption of native Africans from the dis- 
ease, remarks, that the inhabitants of Whidah and Mandin- 
go, after having been naturalized to an atmosphere, often 
heated to 120° and upwards, [eel relief on being removed 
to the relatively cooler settlements in America. Hence 
they enjoy their full vigor in the most hot and sultry parts 
of the West Indies, and of the neighboring continent. Next 
to the Africans, the native Indians of South America are 
enabled to resist the invasion of yellow fever in a more re- 
markable degree than any other people. They are scarce- 
ly more susceptible of the malign influence of the maritime 
regions than the negroes. The English, Anglo-Americans 
and Dutch are observed to be the most violently invaded ; 
the French next; the Spaniards, Portuguese and Italians 
suffer less than either of the former. The yellow fever, ac- 
cording to Dr. Le Blond, is engendered in the road where 
vessels ride at St* Pierre's, in Martinique, among the crews 
of their newly arrived ships rather than in the town. At 
Angustura, he saw a most malignant distemper arise from 
the corrupt quality of the bread which the men were obliged 
to [eed upon. At St. Thomas, on the right bank of the 
Oronoko, there is a great unheallhiness during the summer* 
Putrid bilious fevers affect the inhabitants. And our author 
says, he has no doubt, if an European regiment should ar- 
rive there in the summer, that the yellow fever would break 
out, and destroy the greater part of them. At St. Lucia, in 
17G7, there was as destructive a yellow fever as ever was 
known on board the American vessels anchored in the road, 
while the inhabitants on shore were exempt from it. In one 
vessel not a soul survived; and newcomers fell sick with 
alarming rapidity. At St. Vincents he was repeatedly told 
by the Creoles, that they never heard of the yellow fever- 
until after the arrival of the English. At Cayenne, new 
comers from cold countries contract yellow fever, not by 
catching contagion from any sick person, but from the heat, 
gaseous impregnation, and other qualities of the atmosphere. 
These, while they inspire the natives with health and vigor, 

* Webster's Collection of Papers on Bilious Fevers, p. 70. 
;j: See the Med. Repo3, Vol. X. y. 05, to which I am indebted on this, as 
on many other accasi«ns. 



152 Predisposing and Exciting Causes. 

exert a deadly malignity upon strangers : insomuch that they 
often die on the first or second day of the attack. They 
rarely survive the third, and more rarely still the fifth. The 
unhealthiness of French Guiana, to men from the colder 
climates, is evinced by the unfortunate expedition under 
General Degouges, in 1802. This officer arrived at Cay- 
enne, with a body of three hundred men, in the midst of the 
greatest heats. The atmosphere had become loaded with 
exhalations from the drying and rotten marshes. In about 
a month the yellow fever appeared among the soldiers, and 
in a short time cut otf two hundred of them, together with 
their general, the commandant of the place, and several 
other officers. And although these men were quartered in 
the same barracks with the old battalion and the regiment 
of blacks, not a single one received any contagious impress- 
ion. Only a few hard drinkers among these old standers 
had putrid bilious remittents, which, however, diifered from 
the yellow fever, only by their longer duration and milder 
Symptoms. But the yellow fever, though it favored those 
who had previously been seasoned, was as fatal to the newly 
ai rived passengers and sailors as it was to the soldiers,— 
And while the fresh emigrants were sorely afflicted, the peo- 
ple of the country experienced only the fevers and ordinary 
disorders attendant on calms which succeed the intense 
heats of summer. 

The pernicious influence of miasmatic exhalations to 
foreigners and strangers, is strikingly exemplified in the va- 
rious military expeditions that have been undertaken in tro- 
pical climates. To a destructive mortality occasioned by 
an unhealthy season operating upon constitutions unaccus- 
tomed to the climate, have justly been ascribed the failure 
of Admiral Vernon's expedition to Carthagena in 1741, and 
the unhappy fate of Hosier at Porto Bello in 1746. A sim- 
i lar fate attended the expedition of Genera! Bailing to Span- 
ish South America in 1780. Of 1800 persons who embark- 
ed upon this enterprise, 380 invalids only survived to re- 
turn towards the end of the year. . A similar mortality oc- 
curred among the Europeans who took Fort Roanoak, (a 
town at the bottom of the Bay of Honduras,) in 1779. 

Dr. Blane, in his Observations on the Diseases of Seamen, 
remarks, that it sometimes happens, that a ship, with a long 
established crew, shall be very healthy ; yet if strangers are 
introduced amongst them, who are also healthy, sickness 
w r ill be immediately produced; and Dr. Rush confirms the 
observation of Dr. Blane from the experience of the revolu- 
tionary war, " The history of diseases," says Dr. Rush. 



Predisposing and Exciting Causes* 15"3 

•• furnishes man y proofs of the truth of this assertion. It was 
remarked that while the American army at Cambridge, in 
the year 1775, consisted only of New-Englandmen, (whose 
habits and manners were the same,) there was scarcely any 
sickness among them. It was not till the troops of the east- 
ern, middle, and southern states, met at York- Town and 
Ticonderoga, in the year 1776, that the typhus became uni- 
versal, and spread such peculiar mortality in the armies of 
the United States."* 

Young men from fifteen to five and twenty, especially 
those of a fleshy, sanguine and plethoric habit are more lia- 
ble to fever than those more advanced in life. At the pe- 
riod of five and twenty, the constitution seems to have ac- 
quired its, perfection of vigor and maturity, and is less af- 
fected by the changes of temperature and the seasons; the 
nervous and muscular systems become then less sensible to 
morbific agents, whilst at the same time they acquire more 
strength and steadiness of action. Persons of dry, spare, 
and withered habits ; who look tough, hard, and sun-burnt, 
are much less subject to attacks of fever than the fair, plump, 
moist and florid. It has been thought that women and chil- 
dren are less subject to fever and other malignant disorders 
than men. If this, however, can be admitted as a general 
rule, there are many exceptions to it; and it is well known 
that in the state of Alabama, in 1823, the epidemic was pe- 
culiarly fatal and severe among small children. Dr. Rush 
likewise remarked in the yellow fever which prevailed in 
Philadelphia in 179.3, that children were equally liable to 
be attacked as adults. f 

A scorbutic habit of body may be considered as affording 
a predisposition to an attack of the prevailing epidemic in 
its most malignant form, it was observed by Dr. Huxham, 
that the scorbutic habit of body common to sailors increased 
the malignity of the small pox. | We are also informed by 
Baron Larrc'y, that some navy surgeons with scorbutic hab- 
its, on entering upon the duties of their office to which they 

* Rush's Tnq. & Obs. Vol. I. It has been remarked in Alabama, that 
stocks of healthy cattle, from Tennessee or Kentucky, upon mixing with 
those of Georgia' and the Carolinas, also healthy, become immediately dis- 
eased and die off in great numbers. It has been said, in the way of half 
jest half earnest, that the Georgia and Carolina cattle always carry infec- 
tion about them, but from being accustomed to it are not subject to disease, 
whereas those from Tennessee, being entirely iree from distempers, catch 
the contagion and die. 

t Hush's Inqu. & Obs. Vol. III. 

I Huxliam on Epidemics, Vol. I. p. 94. 

U 



154 Predisposing and Exciting Causes. 

were called, were seized almost immediate]} with the plague 
and died,* 

It has likewise been remarked in the plague^ that persons 
of a dry habit, infants with a line skin and flaxen hair, young 
people of a sangume temperament and irritable fibre, were 
more liable to the plague than those advanced in age. I The 
same observations apply to bilious fever. 

Among the predisposing causes of fever should likewise 
be mentioned the use of animal food and spirituous liquors; 
as tins subject, however, will be considered more folly un- 
der the head of Prevention, I would here just remark that, 
as elsewhere shown, both animal food and distilled spirits 
contribute essentially to produce a scorbutic habit of body, 
to give occasion to the generation of a morbid excess and 
quality of bile, and to produce that state of the system which 
ma} 7 be considered as affording the strongest predisposition 
to fever. By disordering (he function of the liver, they lay 
the foundation of permanent disease in that organ ; a disease 
frequently fatal in our southern climate. This disorder and 
its causes were not unknown to Hippocrates, though wiiie 
was at that time the strongest drink with which mankind 
were acquainted.! 

While all the functions of the body are performed with 
regularity and strength, the system is less susceptible of mor- 
bid action, and less easily impressed by any noxious agent; 
but as soon as this equilibrium and harmony of movement 
are destroyed by any violently exciting or debilitating pow- 
er, a predisposition to fever takes place, and the constitu- 
tion is liable to be invaded by disease ; and the noxious ma- 
terials, which before lay dormant in the body, and might 
have been expelled, or prevented from exerting any injuri- 
ous influence by the natural powers of the system, seize the 
unguarded moment, (if I may be allowed the expression,) 
and immediately exert their deleterious agency. Hence it 
happens that so many are seized immediate!)- subsequent to 
a tit of intoxication : ana hence it is that a healthy constitu- 
tion, and regular and temperate habits, are the best preserv- 
atives against disease. 

* Larrey's Memoirs, Vol I. p. 219. 

t Assalini on the Epidemic Fever or Plague of Egypt, p. 29. 

ij: " la the disease of the liver," says Hippocrates, " there is a pain in 
the regiou 6f this organ, the person loses his former complexion, and be- 
comes of the color of a pomegranate. In the summer season the. di^e-ise 
comes on suddenly; and is produced by the use of beef and drinking wine 
too freely. For at this season of the year these things are mosi. hurtful (o 
the liver, and give a great determination of bile to lids organ." Hij;poc> 
De Intern. Ajftc. Gpcr. Dm. p. 549. 



Predisposing and Exciting Causes, 155 

Cold, or the diminution of heat from a high to a consid- 
erably reduced temperature, may justly be considered as an 
exciting cause of fever. The effect is the same, whether 
applied through the medium of fog, dampness, cold water, 
or cold air- The night air, in low and marshy places, is pe- 
culiarly injurious to health; In a former work,* I took oc- 
casion to observe, that it frequently happened at Plaque- 
mine, upon the Mississippi, that the men who were sent upon 
picquet guard at night returned in the morning affected with 
dysentery or fever. Their station was about half a mile 
from ihe fort,, on the margin of a bayou, a place which was 
extremely low, wet and marshy. Upon my suggestion, a 
large barge was floated down the bayou and moored in the 
stream; on board of .his, the men were more comfortably 
protected from the unwholesome damps and vapors of the 
night; whereby the evils consequent upon exposure, were, 
in a great decree, prevented. Cold being a sedative power, 
it follows that; its effects will be more considerable on the 
body where the latter is in a state of debility, than when un- 
der the opposite circumstances of strength of fibre and ac- 
tivity of the circulation ; for when the circulation is languid, 
the process of generating heat is less energetic, and the nat- 
ural warmth of the body is diminished: under such circum- 
stances, the body is incapable of adapting itself to sudden 
changes of temperature, and the application of cold opera- 
ting with increased power deranges the functions of health. 

There seem to be three reasons why the night air is pe- 
culiarly unhealthy. First, the coldness and dampness of the 
atmosphere, impeding and checking perspiration ; secondly, 
the concentration of febrile miasmata, occasioned by this 
reduced temperature. We know that all fluid and aeriform 
substances are expanded and rarified by heat; and on the 
contrary, that they are concentrated and condensed by cold. 
If, then, marsh miasmata and morbific effluvia are aeriform 
substances, (and I presume no person will contend that they 
are not.) it follows, by a general law, that the more con- 
densed they are in volume, and the greater their concentra- 
tion, in the same proportion are they increased in activity 
and virulence. Whilst, on the other hand, they may be so 
rarified by heat as to lose their infectious quality and become 
perfectly innocent. This seems to be the reason, at least in 
part, why the blowing of the hot land wind puts a stop to 
the plague in Egypt. But it should be understood that the 
heat and effect of this wind cannot be imitated by the feeble 

* Observations on the Topography and Diseases of Louisiana, 



$56 Predisposing and Exciting (Sauses. 

powers of ordinary combustion, no more than the faint glim- 
mering of a candle can rival the mid-day effulgence of the 
sun. Such is the intensity of the heat which accompanies 
this wind* that, in the sensation it produces, it is described 
as coming from the mouth of a furnace. It is Iherefore in 
vain to attempt to put a stop to a prevailing epidemic by the 
kindling in the streets of artificial fires. Excessive heat 
operating upon the human body is found to act as the. exci- 
ting cause of fever. Thus Dr. Rush observes that bakers, 
hatters and blacksmiths were more liable than others to be 
affected by fever. The experiment of kindling fires in the 
street was tried in London during the prevalence of the 
plague; and on the night which succeeded three days that the 
fires had been kept burning, the number of deaths amount- 
ed to 4,009, although during the three or four preceding 
weeks no more than twelve thousand had been destroyed. 
It is said by Dr. Hodges, that the practice of kindling 
fires was found hurtful in the plague of London. " Heaven 
wept," says he, '• for the mistake of kindling them, and 
mercifully put them out with showers of rain. " The same 
experiment was tried at Toulon, when a most fatal plague 
prevailed there in 1721, by kindling, at the sound of the 
bell, a fire in front of every house in the city ; the plague, 
notwithstanding, continued to prevail with unabated vio- 
lence, and in the course often months destroyed two thirds 
of the inhabitants. The same thing was had recourse to 
during the prevalence of the plague at Marseilles, and with 
no better success. 

It has been observed in the preceding paragraph, that 
there are three reasons why the night air is peculiarly un- 
healthy: "First, the coldness and dampness of the atmos- 
phere, impeding and checking perspiration ; secondly, the 
concentration of febrile miasmata occasioned by this redu- 
ced temperature." Thirdly — the third manner in which 
night air proves peculiarly unhealthy, is the attraction which 
moisture has for miasmata. That dampness is favorable to 
the diffusion of marsh miasmata, appears from the circum- 
stance that all natural odours are more perceptible in the 
damp air of the night, immediately after a shower of rain, 
or during the exhalation of the morning dew. Of this fact, 
few, probably, are ignorant, as it must be familiar to all who 
have entered a flower garden or a blooming orchard under 
the circumstances and at the time above mentioned. The 
smell of marshes and of all putrefying and putrescent bodies 
is always more sensible and offensive after night-fall. — 
Odours, which remain unnoticed during the day, become 



Predisposing and Exciting Causes. 157 

very perceptible after sun-set. It is well known that the 
odour of a skunk, which in the day time is palpable only 
at the distance of a few rods, at night, under favorable cir- 
cumstances, is perceptible at the distance of more than a 
mile. 

It appears to be from the disposition of miasmata to at- 
tach themselves to humidity, that a shelter of any kind, by 
excluding, in some degree, the dampness, serves as a pro- 
tection against disease; and it will be at the same time ob- 
vious that the drier the apartment and situation, in the same 
degree will they be found conducive to health. 

One great intention of the sense of smell is to prevent 
our inhaling offensive effluvia. Thus nature points out to 
us the manner in which noxious miasmata prove injurious 
to the system. The circumstance of fever originating in 
this way, Dr. Currie thinks justifies a practice, which he 
has been informed is common among more experienced 
seamen, on the coast of Guinea and other warm climates, 
who, when exposed, during the night, to a breeze from the 
marshes, wrap their heads in a sea cloak, or other covering, 
and sleep fearless on the deck with the rest of their bodies 
exposed. The manner in which this may be explained is 
this ; the moisture on the cloak attracts and arrests the mias- 
mata, and prevents their entrance with the breath. 

Though we do not contend that an atmosphere is unheal- 
thy and infectious in proportion as it is offensive, for we 
know that the air of a particular place may be very offen- 
sive from the putrefaction of a dead animal, and yet no dis- 
ease may be the result; and on the other hand, very viru- 
lent infectious miasms may exist in the atmosphere without 
being perceptible to the sense of smell. All this, however, 
does not prove that this aerial and infectious vapor is abso- 
lutely ivee from odour, any more than if it were contended 
that no water exists in the atmosphere because it is not per- 
ceptible to the sight. Our sense of smell is not remarkably 
acute ; and the matter may be sufficiently virulent to pro- 
duce disease, though it be too much attenuated to be obvi- 
ous to the senses. And as the water in the atmosphere is 
rendered manifest when condensed into drops of rain or 
dew — so may infectious miasmata be concentrated and 
again rendered perceptible by such substances as possess 
an attraction for them. Such appears to be the case 
with most humid bodies, and particularly water, which in 
warm weather, and in unhealthy situations, by standing in a 
vessel soon contracts a disagreeable and offensive smell : 
and in this way infectious vapors being received into the 



158 Predisposing and Exciting Causes, 

mouth and lungs by respiration, and attaching themselves 
to the moisture therein contained, may find admission into 
the mass of circulating fluids* 

The disposition which noxious exhalations have to attach 
themselves to humid substances, is probably the reason why 
fogs in or near wet and marshy places are particularly un- 
healthy : the same circumstance, will explain why exposure 
to the damp air of the night is more injurious than the dry 
air of the day; and it might be a question, if the air were 
entirely deprived of humidity, whether it would not there- 
by be purified from noxious miasmata, and rendered perfect- 
ly healthy. In support of this opinion, as already stated, 
we are informed, that the blowing of the hot land wind, puts 
a stop to the plague in Egypt. This fact :'*ems to be prov- 
ed from the circumstance of an opposite state of the at- 
mosphere being found so injurious to the system, and so 
favorable to the propagation of disease. It has been ob- 
served in epidemics, as typhus, small pox, plague, &c. that 
their activity and virulence are increased by a stagnant, 
damp and foggy state of the atmosphere ; and that they de- 
crease when the weather is dry and moderately warm. It 
was remarked by Dr. Smith, that a contagious patient be- 
comes greatly more so when his clothes are wet and his 
body heated by exercise, so as to be in a state of perspira- 
tion. In illustration of the same fact, it was observed by 
Volney, that in Egypt the winter increases (fomente) the 
plague, because it is mild and damp; and that the summer 
destroys it because it is hot and dry, (" Pete la dctruit, parce- 
que il est chaud et sec." It is remarked by Dr. Brockles- 
by, that he found nothing more productive of ague than sol- 
diers lying on the damp ground in camp. Dr> Lind repre- 
sents the employment of cutting wood and clearing the land 
of trees and bushes as extremely unhealthy; and gives in- 
stances in illustration of the circumstance. He likewise 
cautions against exposure to the night air in swampy and 
unhealthy countries, or where there are great night fogs, 
" The duty alone,'* says he, "of fetching fresh killed butch- 
ers' meat at night, for the use of our ships' companies in 
the East and West Indies, has destroyed every year several 
hundred seamen. In those parts of the world butchers' 
meat must be brought on board at night, immediately after 
it is killed, otherwise it will not be fit for use the next day. 
During the sickly season at Batnvia, a boat belonging to 
the Med way, which attended on shore every night, was 
three times successively manned, not one having survived 
that service. They were all taken ill at night when on 



Predisposing and Exciting Causes, ] 59 

shore ; so that the officers were at length obliged to employ 
none, but the natives of the country on the business."* It 
is probably upon the principle of the attraction existing be- 
tween water and miasmata, that vessels lying at a short dis- 
tance from an unhealthy shore remain secure and exempt 
from disease ; the miasms being absorbed by and blended 
with the water. Thus, we are informed by Dr. Rush, that 
many persons escaped the yellow fever of 1793 in Philadel- 
phia, by remaining on board of vessels anchored in the mid- 
dle of the Delaware. It is perhaps from this circumstance 
that the water carriers at Cairo, according to Mr. Volney, 
escape the plague. Does not the attraction which water 
possesses far infectious miasmata suggest the propriety of 
keeping vessels filled with this element in the rooms of fe- 
brile patients, removing it from time to time as it becomes 
charged with -infection ? 

It has been observed that the first high grounds in the vi- 
cinity of noxious exhalations or the low grounds near to the 
source of such infectious vapors, are more unhealthy than 
the plains below. This circumstance may be accounted for 
upon the presumption that the infectious miasms attach 
themselves to the particles of moisture that are exhaled 
from the low grounds or marshes, and which are observed 
to be attracted by and to settle upon ihe neighboring mills. 
Points and eminences are objects of attraction both of elec- 
tricity and vapors, and fogs before they are dissipated are 
observed to settle upon the higher eminences of the adja- 
cent hills. 

From the power of cold in concentrating infectious mias- 
mata, we may also account for the frequent increase of ma- 
lignant epidemics at the approach of cool weather. The 
fever of 1 79.3 in Philadelphia, proved most fatal in the latter 
part of October. In this epidemic, we are told by Dr. Rush, 
that the night air, even in the warm month of September, 
was often so cold as to excite the disease, when the dress 
and bed- clothing were not adapted to it; and that every 
change in the weather, that was less than that which produ- 
ced frost, evidently increased the number of sick people. 
This was obvious after the 10th arid 19th of September, 
when the mercury fell to 44° and 45°. " The hopes of the 
city received a severe disappointment on this occasion, for 
I well recollect," says the Doctor, " there was a general 
expectation that the change in the weather would have 

* Lind on the Diseases incidental to Europeans in Hot Climates, p. 152, 



160 Predisposing and Exciting Causes, 

checked the disease." The same increase of the number 
of sick was observed to follow the cool weather which suc- 
ceeded the 6th and 7th of October, on which da)S the mer- 
cury fell to 43° and 46°.* 

It was observed by Sydenham, that the greatest mortality 
of the plague happened about the autumnal equinox ; and 
the same author advances the position, that the effects of 
cold upon the human body, have exceeded the combined 
ravages of war, pestilence and famine. t 

As to the influence of the protracted use of cold bathing 
in exciting both intermitting and remitting fevers, many in- 
stances have fallen under my own observation. During 
my residence in Louisiana, many of the soldiers were in the 
daily habit of swimming and bathing in the river; and in the 
indulgence of this amusement, frequently remained in the 
water above half an hour at a time ; in consequence of which 
it not unusually happened, that three or four of the number 
would be reported sick on the ensuing day with fever and 
ague, frequently relapsing and running into the bilious re- 
mittent. This injurious practice was at length limited to 
once a week, after which the attacks were less frequent. 

Captain Delano, speaking of the practice which his com- 
pany were in, of bathing in the river at the island of Timor, 
says, " we paid dearly for the pleasure of fresh water bathing. 
We took it so frequently, and staid in the water so long* that 
we brought on intermittent fevers, and several of our offi- 
cers died. All would have died, had we not left off this in- 
dulgence. Europeans must be always cautious how they 
bathe in ke^h water in hot countries. The effects of it in 
Timor is not the first instance of the kind which I have 
known from personal observation."! 

Low and damp places, by favoring the diffusion of mias- 
mata, are more unhealthy than those (hat are high, dry and 
broken. For the same reason those who live on the ground 
floor are more obnoxious to fever than those who live in the 
upper stories of the same houses. Dr. Russel, during his 
residence at Aleppo, was in the practice of prescribing, from 
the second story to several hundred of pestilential patients, 
who assembled every morning beneath his window. 

In many parts of our country we see people with sallow, 
sickly, and bloated countenances, inhabiting the vicini- 
ty of a low and marshy valley or reed brake, for the sake 

* Med. Inq. & Obs. Vol. IN. p. 91, 92. 

t Sydenham's Works, p. 74. 

J Delano's Voyages, Boston, 1817, p. 107. 



Predisposing and Exciting Causes, 169 

of convenience to water, and who, by fixing their residence 
at a greater distance, instead of agues and dropsies, might 
enjoy health and longevity. 

It is observed by Dv. Munro, that the more moist the 
season, the more subject an army is to agues* A damp air 
and (o'*£v weather have always been found to be more fa- 
yorable for the origin and spreading of malignant diseases, 
partly on account of the reason already assigned, as facilita- 
ting putrefaction, and favoring the diffusion of morbid poison, 
and partly by checking perspiration. Dr. Lind and Dr. 
Smith supposed that a damp air increased the strength of 
contagion; from the idea that humidity was more favorable 
to its diffusion through the atmosphere. 

Assalini observed that the citadel of Cairo, on account of 
its elevated situation, preserved the inhabitants of this fort 
and its environs from the plague. " If the inhabitants of this 
fort," says he, "in spite of their daily intercourse with those 
of the city, were preserved from this disease, it must be be- 
cause the damp and infected air, which had destroyed the 
health of the inhabitants of Lower Cairo had not sufficient 
elevation to reach the highest part of the citadel and its 
environs, and consequently could not impair the health of 
those who lived there."* 

The presumption is, that infectious miasmata are mostly 
confined to the surface of the earth, and never rise to any 
considerable distance above it ; or if they do, by being blend- 
ed and diluted with the common atmosphere, they lose their 
virulence and infectious property. 

The circumstances under which the application of cold to 
the body proves most prejudicial, are, on the part of the per- 
son, debility ; and with respect to the cold itself, a sudden 
transition from a high to a reduced temperature, its protract- 
ed application to the body, together with a state of dampness. 
When applied to the surface of the body through the medi- 
um of wet clothing, its power and effects are more immedi- 
ate and prejudicial than when applied to the inner superficies 
of the lungs, by respiration. As water is a denser medium 
than air, its application will convey a stronger sensation to 
the body than air of the same temperature ; partly because 
it is a more rapid and better conductor of heat; but it is 
principally on account of the evaporation which takes place 
from the surface of the body when a person has become wet 
in a shower, that the sensation of coid is experienced. Wa- 
ter is here only the medium by which the cold acts upon the 

;; A^alini on the Epidemic of Egypt, p. 58, 
W 



170 Predisposing and Exciting Causes, 

body, and provided no evaporation took place, the sensa- 
tion of cold would not be produced, nor would any evil con- 
sequences ensue. 

Dr. Lind advises that in unhealthy cli mates and situations, 
as the East and West Indies, the crews of vessels be kept 
at work, upon deck, as little as the nature of the service will 
permit, before sun-rise and after sun-setting, and only when 
the sea breeze blows. This advice is founded upon the 
conclusion, that when the sun is above the horizon, the nox- 
ious land vapors are more dispersed ; they are then much 
rarer than in the night, or even in the evenings and morn- 
ings when they become denser and more apt to infect, and 
when the atmosphere is more charged with miasmata in 
consequence of its greater humidity. Dr. Lind relates it 
as a matter of constant experience, that the greatest suffer- 
ers in unhealthy harbors are the boats' crews, and such as 
being employed in the necessary business of wooding and 
watering the ship, are obliged to sleep on shore, where they 
are exposed to the unwholesome land air: since in sieep 
their bodies are in a state of relaxation, and in the greatest 
danger of infection. We are further told by the above 
named author, that this circumstance is so well known at 
Rome, that scarce an inhabitant of comfortable circumstan- 
ces would venture, during the summer and autumn, to sleep 
a night at Ostia, or in the neighborhood of the marshes ad- 
joining the city. " A clergyman of long observation in such 
matters," says Dr. Lind, " assured me that few of the farm- 
ers, reputed early risers in his parish, which is near the level 
coast of Holderness, live to be old."* 

It has been suggested by some, that the moon in its chan- 
ges has an influence upon the constitution in disposing the 
body to be affected by intermittents. This opinion has been 
advanced and defended by Dr. Jackson, Dr. Lind, and Dr. 
Balfour ; though the two latter, from subsequent experience, 
seem to have receded from their former belief. The ideal in- 
fluence of the moon and stars upon the human body, is a relic 
of the old astrology, witchcraft and superstition, which gov- 
erned and led the weak minded in the days of our Trans-At- 
lantic ancestors. The mind, as well as the body, was thought 
to be under the influence of the queen mistress of the night, 
and persons laboring under derangement were the supposed 
victims of her displeasure, and, in compliment to her di- 
vinity, styled lunatics. It would appear, however, that i lie 
only remote influence which the moon can have in the pro- 

* Line! oo the Diseases of Seamen, p. 13-4, 






Predisposing and Exciting Causes, 1^1 

duction of disease, is by occasioning, at the change and full, 
a greater elevation of the tide, which upon receding leaves 
the marshy grounds, with the animal and vegetable matter, 
to undergo putrefaction. This effect will be most remark- 
able in warm climates, where the land is low and subject to 
inundation. As marsh miasmata, as well as contagion, are 
limited in the extent of their diffusion, a removal to a short 
distance from these infected places, will be sufficient to en- 
sure safety and protection from such noxious exhalations. 
Among the natives and old residents of warm and unheal-* 
thy climates, the miasmata, or semina of disease, frequently 
lie dormant and inactive in the body, producing little or no 
derangement of the health ; the constitution, from long habit, 
being accustomed to those unwholesome exhalations, be- 
comes, in a great degree, insensible to their operation. — 
They, however, frequently, in such persons, give occasion 
to an increased secretion of bile, which, after accumulating 
in considerable quantity, often effects its own expulsion, 
either by vomiting or stool ; and, as observed by Dr. Clark,* 
we may frequently see the natives of warm climates vomit- 
ing and discharging great quantities of bile one hour, and 
the next hour riding into the country, quite relieved from 
every symptom of indisposition. 



* Observations on the Diseases -which prevail in Long Voyagei to Hot 
Countries. 



17$ Operation of the Remote Cause's?. 



CHAPTER IV 



OPERATION OF THE REMOTE CAUSES. 



Of the primary mode in which Infection or Miasma comes to 
operate upon the System in the production of Disease. 

That marsh miasmata, and the exhalations from putrefy- 
ing animal and vegetable matters, in any other situations. 
act as the essential causes of endemic fever, there are pro- 
bably but few who have the skepticism to doubt. 

There appear to be but three ways in which ihe prima- 
ry operation and impression of febrile infection in producing 
disease can be explained. 

1st, Either by referring this effect to its action on the 
surface of the body ; or, 

2dly, On the lungs through the medium of respiration ; or, 

3dly-,'On the stomach and bowels. 

A secondary consideration is, whether its operation ia 
the production of fever is upon the vascular or nervous 
system. 

Darwin, Gardiner, Turner, Senac, Lind, Hunter and Bal- 
four, were of opinion that the infection of fever is received 
into the stomach; and this seems to have been the prevail- 
ing opinion among those ph) sicians who have expressed 
their sentiments upon the subject. 

The opinion of Dr. Ferrier that infection may produce 
disease by direct impression on the olfactory nerves, is 
scarcely entitled to consideration. 

Dr. Moseley seems to express a belief, that pestilential 
fevers are produced by a primary impression on the surface 
of the body. 

Fernelius, Pugnet. Bell and Currie express their belief 
of the infection being received by the lungs in respiration. 

Fracastorius seems doubtful whether contagion is not 
communicated by absorption from the surface of the body; 
but at the same time supposes that in the majority of cases 
it finds admission from the air in respiration. 



Operation of the Remote tSause&f }?$ 

With regard to the opinion of infection* being received 
into the stomach, it may be observed, that the inference is 
drawn from appearances not altogether satisfactory and 
conclusive, viz. the nausea and vomiting which frequently 
occur at the commencement of fever. But these symptoms 
are also common in other cases, wherein we know that no 
infection has been received in this manner, and consequent- 
ly that this disorder of the primae vias may be satisfactorily 
accounted for from an affection of the general system. This 
is exemplified in the inoculated small pox. It is well known 
that the stomach is a very important organ, and much dis- 
posed to sympathize in affections of the whole or of partic- 
ular parts of the system. It is upon the healthy condition 
of this viscus that the soundness of every part of the animal 
economy essential depends. Pain destroys the appetite, as 
do also distressing passions and affections of the mind. A 
dissection of a dog by Dr. Cooper, that died wilh hydropho- 
bia, exhibited all the usual marks of inflammation and effu- 
sion which take place in common malignant fever. And 
the affections of the stomach in this disease are no less re- 
markable than in the yellow fever : such as nausea, a burn- 
ing sensation in the stomach, vomiting and costiveness. So 
that this affection of the stomach can afford no proof of the 
morbific matter of fever, being primarily applied to it. But 
in relation to the manner in which infection is received, is 
it not improbable that a sufficient quantity of the febrile vi- 
rus should have been absorbed by the saliva, to produce dis- 
ease ? It is well known that the symptoms of fever have 
been suddenly produced, in consequence of a few moments- 
exposure to virulent and concentrated febrile infection. — 
Lancissi, Lind, Pringle, &c. give instances of persons who 
were exposed to the exhalations of marshes, being suddenly 
affected with sickness, vomiting, delirium, and other symp- 
toms of fever, which continued till the disease had run its 
usual course. In such instances the short period of expo- 

* As I may frequently have occasion to make use of the words infection 
and infectious, it is proper to define the sense and acceptation in which \ 
employ them, in order to draw the line of distinction between infection and 
contagion. For this purpose I would observe, that an impure atmosphere, 
whether occasioned by animal putrefaction, marsh miasmata, or other cau- 
se* capable of producing disease in the person who breathes it, is infectious; 
and where disease is communicated from one sick person to another, either 
through the medium of the air or by contact, it is understood to be conta- 
gious, though in both instances the matter producing disease may, with the 
strictest propriety, be called infection. The first may be styled the infec- 
tion from putrefaction, or infection from external causes ; the other the in- 
fection from disease. 



174 Operation of the Remote Causes, 

sure, and the sudden and violent commotion produced would 
seem to forbid the idea that the morbific virus had affected 
the sanguiferous system through the medium of the primae 
viae- Moreover, instances are recorded wherein persons 
have swallowed the infection of small pox and lues venerea 
with impunity.* Again ; persons, from sleeping in un- 
healthy places on shore, have received the seeds of a fever, 
which did not ripen into disease till after the vessel had 
been ten or fifteen days at sea ;t can we suppose that the 
semina of disease could have lain all this time in the primae 
viae without having sooner disordered the functions of health ? 
Besides, we know that very offensive things have been taken 
into the stomach as articles of food, or otherwise, either with 
impunity, or else the offending substances have effected their 
own expulsion by vomiting, or by the production of diar- 
rhoea, which ceased as soon as the offending matter was ex- 
pelled. These miasmata are aeriform substances ; and we 
know that carbonic acid gas, an aerial fluid, the most de- 
structive to animal life when received into the lungs by res- 
piration, is perfectly innocent and even salutary when taken 
into the stomach. 

It is scarcely consistent with the present state of anatomi- 
cal and physiological sciences to suppose that disease is 
communicated through the medium of the surface of the 
body. The cuticle is destitute of nerves and blood vessels, 

* We are informed by Dr. Rush, that in Maryland, the negroes eat, with 
safety, the flesh of hogs that have been previously bitten by mad dogs ; and 
that he has heard of the milk of a cow, at Charleston, in the same state, hav- 
ing been used, without any inconvenience, by a whole family, on the same 
day in which she was affected with this disease, and which killed her in a 
few hours. In confirmation of similar facts, he quotes the authority of Dr. 
Baumgarten, in the Medical Commentaries, who observes that the flesh and 
milk of rabid animals have been eaten with perfect impunity. Rush's Inq. 
mid Obs. Vol. II. p. 326. No direct conclusions, however, can be drawn 
from these circumstances ; and as to the venereal matter being swallowed, 
as related by Bell, Hunter and others, without producing any disorder, we 
sho«ld recollect that the stomach possesses the power of changing the qual- 
ity of most substances taken into it — that the gastric juice or fluid is a pow- 
erful agent — and that as the stomachs of all animals Vsot exclusively carni- 
vorous, contain a greater or less quantity of acid, of course all alkaline 
substances will become neutralized ; and whether alkaline or not, will be 
snaterially changed from their original qualities. But there is a point be- 
yond which this corrective agency of the stomach ceases, and where the 
poison received abounds in excess, in consequence of the quantity being 
too great for the neutralizing or corrective power of the stomach, the same 
effect will be produced as if the infection had been immediately received 
into the mass of circulating fluids. This appears from the experiments of 
Fontana, which will be hereafter noticed. 

t Badinach. Med. Obs. & Inq. Vol. VL Blane on the Diseases of Sea.- 
men, Lind on Hot Climates. 



Operation of the Remote Causes, 17£ : 

and, therefore, seems to be incapable of sensation, or per- 
forming the function of absorption; and in order for the 
miasmata of disease to act upon the system, from applica- 
tion to the surface they muet enter the pores of the cuticle 
by absorption. But physiological researches, as well as the 
phenomena of health and the symptoms of disease, seem to 
prove that transpiration, and not absorption, takes place 
from the surface of the body. Doctors Rosseau, Clapp and 
Dangerfield, have illustrated this subject in their experi- 
mental inquiries,* from which it appears that even spirits of 
turpentine, when applied to the body in the form of a bath, 
does not impregnate the urine with its odour, provided 
the person avoids the vapor, by breathing the external air 
through a tube ; but that the impregnation becomes very 
pungent from breathing the vapor for a short time, though 
the spirits had not been applied to the surface. The same 
experiments were made with mercurial ointment and with 
a similar result, with this difference, that the person who 
applied the friction to the others protected his hand by a 
glove, but being exposed to the vapor through the medium 
of respiration, he became impregnated with the mercury, 
whilst the others to whom the mercurial ointment was ap- 
plied, and who avoided the mercurial vapor, remained un- 
affected. Richerand, however, who stands high as a physi- 
ologist, is of opinion that absorption does take place by the 
skin, and founds his opinion on the following arguments. — 
" The increase of the weight of the body after walking in 
damp weather; the abundant secretion of urine after re- 
maining some time in a bath; the evident swelling of the 
inguinal glands after long continued immersion of the feet 
in water, an experiment often made on himself by Mascag- 
ni ; the effects of mercury administered by friction, &c. ; 
incontestibly prove that absorption is effected by the skin, 
under different circumstances with more or less activity."! 
In support of the same opinion, it was found by Stuart that 
the color of the urine was increased by the immersion of the 
body for an hour or two in a bath tinctured by an infusion 
of madder, rhubarb, &c.J The instances brought forward 
by Richerand, however, are most of them explicable by re- 
ferring them to the absorbing power of the lungs. A curi- 
ous fact in support of cutaneous absorption is mentioned by 

* See their Dissertations on Cutaneous Absorption in Caldwell's Collec- 
tion of Medical Theses. 

t Richerand's Physiology. On Absorption. 

I See Experiments and Observations in defence of the doctrine of Cuta- 
neous Absorption. By Josephus B, Stuart of Aibafty. 



1 76- Operation of the Remote Causes, 

Dr. Simpson, of a youth who, laboring under a fever, was 
seized with a diarrhoea; whilst in a state of stupor, his 
whole body was burning with the fever, no drink could be 
administered, nor his mouth moistened ; in this condition his 
feet were immersed in cold water, upon which the fluid in 
the vessel suddenly diminished in quantity, and the same 
water, scarcely colored, was immediately discharged per 
anum, as if from the operation of a cathartic* If in cer- 
tain instances absorption does take place from the surface, 
the presumption is, that this is not effected in any consider- 
able degree under ordinary circumstances, to which the 
garments that invest the body would form a considerable 
obstruction. 

The modern experiments of chemists would seem to 
prove that absorption by the lungs is not required in order 
that the necessary changes may be effected on the blood by 
the aciion of the atmospheric air; that the change of the 
blood, from venous to arterial, is effected in the lungs, prin- 
cipally by the loss of its carbon which is given out, and com- 
bining with the oxygen received by inspiration, forms car- 
bonic acid gas, which is thrown off with the aqueous vapor 
and the unconsumed nitrogen. If absorption can take place 
from the surface of the body, we may reasonably suppose 
that this process is effected with more facility by the lungs, 
where the membrane interposed between the blood vessels 
and absorbents and the air received in respiration is much 
more delicate and thin than the cuticle. And although 
oxygen itself may not be absorbed, this does not foibid (he 
supposition that other aerial substances may find admission. 
Lymphatic and absorbent vessels we know are plentifully 
distributed through every part of the animal frame, and we 
should suppose that in such an organ as the lungs, the ab- 
sorbing power would be nearly as great upon their contents 
as those of stomach and bowels are upon the chymous fluid. 
In support of this opinion it may be remarked, that Fontana 
found, whilst he was under the operation of a brisk purga- 
tive, that his weight was increased several ounces during a 
walk in the evening for an hour or two, when the atmos- 
phere was moist. A case still more striking is relaled by 
Dr. Watson. A boy who had been sweated and starved 
down to a certain weight, in order to fit him as a rider in a 
horse race, acquired an additional weight of thirty ounces 
in the course of an hour, though he had only drank half a 

* Simpson De Re Me&ica, p. 183, quoted by Percival. Ess. Med. & Ex> 
per. Vol. H.p. \B2- 



Operation of the Remote Causes-. 177 

2^a?? of wine in the interval. "There are many cases," 
says Dr. Robertson, from whom I have borrowed the above 
instance, * ; where the quantity of urine voided by a diabe- 
tic patient, is not lessened, even when the skin has been 
covered with greasy applications ; and in such instances, 
(he excretion in this way has been found to exceed the 
whole injesta : in these cases, the absorption of water could 
only take place through the lungs.* The following fact 
gives, likewise, an additional continuation of this opinion. 
Several people, who were under the necessity of passing 
their time in a very damp situation, perceived that they had 
regular calls during the night to pass urine ; which took 
place repeatedly when their skins were covered with per- 
spiration, and after a dinner of animal food, with a few 
glasses of wine, and when no supper, or any liquid had been 
taken for many hours before going to bed. This circum- 
stance continued to be the case for several weeks, till the 
increasing temperature of the atmosphere rendered their 
situation somewhat drier.f 

Goodwin thought he had observed a considerable ab- 
sorption of nitrogen or azotic gas in respiration; but his 
experiments on this subject were not decisive, and were 
consequently disregarded. The later experiments of Mr. 
now Sir Humphrey Davy, put the fact beyond a doubt ; and 
if any confirmation of it were wanted, it is furnished by 
the experiments of M. PfarT. It is remarked by the editors 
of the Medical and Chirurgical Review, that the azote or 
nitrogen absorbed during respiration, enters into the com- 
position of the fluids, and serves to render them more high- 
ly animahzed or azotized. In this way, say they, we may 
account for the transformation of chyle into blood, during 
its passage through the lungs. Besides, in animals exclu- 
sively herbivorous, whose muscular fibres consist of a great 
proportion of nitrogen in a solid state, there is no other way 
of satisfactorily accounting for the entrance of this element 
info the composition of the body, except from its absorption 
from the atmosphere. It is related by Dr. Kiel that a young 

* The argument "which the Doctor draws from this fact, though plausi- 
ble, is not conclu?ive. For we know that, in diabetes there is a rapid wast- 
ing of the body, and we ibc-etbre conclude that ihe solids themselves are 
melted down, taken up hy the absorbents, and carried off' by urine ; so that 
ur.dess the quantity of urine voided exceeds both the injesta and the wasting 
of the hod)', making due allowance for pulmonary and catamous perspira- 
tion, we cannot reasonably suppose that any absorption has taken place by 
the lungs or skin. 

r JloberUon's History of the Atmosphere and Epidemics, V r ol. II. p. 301. 
X 



173 Operation of the Remote Causes. 

man gained, after much fatigue, during the space of one 
night, sixteen ounces. The vapour of melted lead will ex- 
cite the colica pictoneum in those who are exposed to it, 
as is the case with plumbers, potters, and shot makers ; and 
globules of mercury have been found in the bones of the 
skulls of those whose occupation obliged them to be expo- 
sed to the vapor of this metal. It has also been ascertained 
that the absorbing power of the pulmonary lymphatics is 
much increased by long fasting and a state of inanition. 
From which we deduce the important practical conclusion, 
that it is dangerous to expose one's self to infection with an 
empty stomach. 

We know thai the noxious exhalations which produce fe- 
ver are in an aeriform state; they must, therefore, necessa- 
rily be received into the lungs in respiration, and by being 
immediately applied to the mouths of the pulmonary ab- 
sorbents, may thereby be received into the mass of circula- 
ting fluids. It does not appear that the absoi bents possess 
any particular appetency, or discriminating power, whereby 
they reject such substances as are deleterious, and receive 
only those which are salutary ; were this the case, mankind 
would be exempt from an infinite number of calamities : but 
we find that these delicate vessels absorb with apparent in- 
difference the blandest lymph, the venereal or pestilential 
virus, the small pox infection, or any other matter of suffi- 
cient tenuity for their reception.* 

It has been generally supposed that carbonic acid gas 
proves destructive to animal life, merely by its negative 
properties in excluding vital air, and thereby preventing 
the purifying operation of the latter on the blood as it cir- 
culates through the lung;. It appears, however, that the 
deleterious property of carbonic acid gas is owing, not so 
much to its negative qualities, as to its absolutely deleteri- 
ous properly. It is slated by Mr. J. Hunter, that fishes will 
survive longer in water deprived of air, than in that which 
is impregnated with carbonic acid ; and it is observed by 
Dr. Black, that when the respiration of birds is prevented 
by closing their nostrils with suet, they live longer in carbo- 
nic acid gas, than when they are permitted to inhale it. It 
would appear, therefore, that in such instances carbonic 
acid, or the carbon separated from the oxygen, enters the 
circulation and acts immediately upon the heart and arte- 
ries. The venous blood returned to the heart abounds with 



* The lacteals and lymphatic?, says Mr. Cruickshank, take up the most 
irritating substances, Anat. of the Absorb. Ves. p. 123. 



Operation of the Remote Gentses, 179 

an excess of carbon, which it is the function of the lungs to 
separate, but if instead of this, it becomes still more highly 
carbonized, as by the respiration of carbonic acid, life will 
be more speedily destroyed than by a mere negation of the 
common atmosphere. 

It is ascertained that vegetable, mineral, and morbid poi- 
sons are taken up by the lymphatic of the stomach and bow- 
els. Of this, instances v. jil be given hereafter. But to il- 
lustrate the fact that morbid poisons will act upon the gen- 
eral system when taken into the stomach, it may not be ir- 
relevant to notice the following fact. A poor man is men- 
tioned in the Medical Repository, who, unable to pay the 
expense of inoculation, and being himself ignorant of the 
process, procured a quantity of the variolous scabs, and hav- 
ing pulverized them, spread them plentifully on a piece of 
bread and butter, which he gave to his children, and with 
the desired success; we are further informed that the dQg, 
also, who partook of the repast, was in like manner seized 
with the small pox.* 

Admitting that the infection producing fever is received 
into the primas viae, the quantity to take effect must, to use 
a common expression, be infinitely greater than if received 
by the lungs : for we know that the stomach possesses the 
power of changing the qualities of substances taken into it, 
in such a manner as to convert them to a different nature. 



* Med. Repos. Vol. I. p. 247. It may be considered as a physical fact, 
thai, in general, the inferior order of animals, or the brute creation, are 
not subject to the same diseases from morbid poisons and from pestilen- 
tial constitutions of the atmosphere as the human race; to this, however, 
exceptions are recorded by different authors. We are informed by a res- 
pectable writer, that in an epidemic season of the confluent small pox, tur- 
keys, fowl? and other poultry were carried off by the disease in great num- 
bers, and had the same symptoms usually accompanying every stage of this 
distemper in the human species. HolwelV s acco tint of the manner of inocu- 
lation, as quoted by Walker on Small Pox. It is remarked by Dr. Rush, 
that malignant a\id mortal epidemics are often preceded by uncommon 
sickness and mortality among certain birds and beasts. They have both 
appeared among wild pigeons and cats in the United States. The mortality 
among cats, previous to the appearance of epidemics, has been taken notice 
of in other countries. Dr. Willan says it occurred in the city of London, 
between the 20th of March and the 20th of April, in the year 1797, before 
a sickly season, and Dr. Bur.eiva says it preceded a mortal epidemic in 
Paris. The same thing was observed in the plague which prevailed io 
Rome, B. C. 461, which, according to Livy, affected both men and cattle 
with equal malignity. And it is said by Dionysius of Halicarnassus, that 
the disease seized horses, herds of cattle, and flocks of goats and sheep. We 
are also told by Orosius, that the plague which originated in Africa, B. 0. 
126, was not confined solely to the human species, but that a general mor- 
tality of birds, cattle and wild beasts marked the progress of its] destruc- 
tive ravages. 



389 Operation of the Remote Causa. 

Thus, in various instances, (be variolous infection, (not, how- 
ever, in the quantity above mentioned.) the virus of hydro- 
phobia and of the venereal have been swallowed without 
producing any inconvenience or indisposition* Non gti&iu, 
sed in zulnere nocent, says Ceisus, '"poisons do not prove 
injurious from being taken by the mouth, but from the in- 
fliction of a wound." Flenk observes, that the poison of 
vipers is taken with impunity into the stomach.! The fam- 
ilies of the Psylli in Africa, and of the Marsi in Ifpiy, were 
supposed to cure the bites of venomous serpents by the 
power of enchantment, or by some invulnerable idiosyncrasy 
of constitution ; and what was then surprising to the vulvar, 
that they should suck out the venom of the wound with their 
mouths and remain uninjured, is divested of mysieiy by- 
physiological knowledge. J It is said that the woorara poi- 
son may be taken into the stomach without any ill conse- 
quence ensuing. § 

These facts do not prove absolutely that poison in any 
quantity taken into the stomach is innocent and free from 
danger, they only prove that the quantity received was not 
sufficiently great to withstand the neutralizing powers of 
the stomach. And there can be no doubt that had the quan- 
tity been much larger, the effect won id have been as fatal 
as if it had been inserted into a wound. 

It appears from the experiments of Fontana, that poison 
acts in proportion to its quantity and the size of the animal 
to be acted upon ; that, for instance, the thousandth part of 
a grain is sufficient to kill a sparrow, by introducing the 
venom immediately into the muscle by incision. Suppo- 
sing the sparrow to weigh an ounce, he calculates that 
twelve grains of venom will be necessary for the destruc- 
tion of an ox of 7501b. ; and two grains and a half to kil] a 
man, supposing him to weigh 1 50lb. ; that admitting a viper 
to contain two grains of venom, it will require the venom 
of six vipers to kill an ox, and nearly two to kill a man ; 
but as the viper does not discharge all its venom at a bite, 
it may require twenty vipers, each biting onjy once, to 



* Galen de Temperaments, lib. iii. cap. ii. Mead's Works, p. 151* Fo- 
dre. Med. Leg. torn. iii. p. 674. Rush's Med. Inq. & Obs. Vol. III. p. 409. 
Hunter on the Venereal. Eell on the Venereal. 

t Venenuin riperinnm ventriculo ingeitum impune fertur. Toxicolog, 
p. 10. See also Boerhaave de Morb. Ner. torn. i. p. 207. Rhedi. Obs. on 
Vipers, &c. p. 17. 

% See Mead's Works, p. 29. Plin. Hist. Nat. lib. vii. cap. 2. JElian. Hist. 
Animal, lib. i. c. 5tf, and Lucan, lib. ix. ver. 891. 

§ JDr. Bancroft's History of Gciiana-. 



Operation of the Remote Causes. 181 

kill an ox, and five or six with the same restriction to kill a 
man.* 

But it appears that it requires a thousand times as much 
to produce death when the venom is received into the sto- 
mach as when inserted in a wound. Thus six grains were 
necessary to kill a pigeon when the venom was given by the 
mouth ; and according to the same calculation, live ounces, 
or the venom of 240 vipers, are required to kill a man in 
the same way.f It appears also from the experiments of 
M. Delile of Paris, that a larger quantity of the poison of 
the Bohon Upas, or the Upas Tituete of Java, is necessary 
to destroy an animal when taken into the stomach, than 
when it is inserted into a wound. Such is the power of the 
stomach in changing, resisting or neutralizing poisons. — 
However interesting, it does not come within the limits of 
my present inquiry to examine and discuss the action of 
morbid poisons in all their various modes of operation ; this 
much, however, was thought necessary in the investigation 
of the subject under consideration, it is not conclusively 
proved, however, from what has been advanced, that the in- 
fection of fever may not come to act upon the system through 
the medium of the stomach and bowels; it shows, however, 
that its chance of affecting the general system is much weak- 
ened, and that a large quantity is required to take effect 
when received into the stomach. 

In support of the opinion that the infection is received by 
the way of the lungs, we have previously noticed (page 60) 
the circumstance mentioned by Dr. Lind, of the marines 
being suddenly taken ill while exercising on the South Sea 
beach; as also the instances mentioned by Lancissi,j of a 
company of gentlemen and ladies being suddenly attacked 
with fever, from exposure to marshy exhalations, whilst re- 
turning to Rome from an excursion of pleasure ; likewise 
the instances of sudden death, § and the cases of fever im- 
mediately produced in 114 persons by the vapor which is- 
sued from a coffin, mentioned by Pierre Cotte. Similar in- 
stances are quoted by Sir John Pringle, from Stow's Chron- 
icle, of several hundred persons being suffocated and sud- 
denly attacked with fever from the air of an infected prison. 

It may be urged that in those cases where death or suffo- 
cation is instantly produced by exposure to noxious effluvia, 
the effect must be ascribed to their immediate operation, on 

* Fontana on Poisons, Vol. I. p. 286-7. 
t Ibid. 

$ See page 60 of the present work. 
§ See page 73. 



182 Operation of the Remote Causes, 

the nervous system :•* this is probable ; for we know that ia 
many instances the symptoms suddenly occasioned in this 
manner subside and disappear, without terminating in an 
established fever; and therefore conclude that the aifection 
has been merely nervous ; but when fever is the conse- 
quence of such exposure, a reference to the nervous system 
alone, will not explain the circumstance : for did these fe- 
brile agents act exclusively upon the nerves, it would be 
reasonable to suppose that no perceptible time would be 
necessary to elapse between the application of the cause 
and the appearance of the effect : for experience teaches us 
that stimuli, or agents applied to the nerves, evince their 
immediate operation : besides, were the action of these 
causes confined to the nervous system alone, should we not 
embrace an improbability in supposing that they eouip 1 lie 
in contact with the nervous expansion, in the air ceils of the 
lungs, or in the nose, trachea, or stomach, for the space of 
ten or fifteen days, and then, and not till then, exert, for the 
first time, their deleterious operation? In the meantime, 
what should hinder their being expelled with the same 
breath by which they found admission, or of being carried 
off by stool ? H their mere presence in the lungs or stomach, 
without being taken into the circulation, were ail that is re- 
quired in the production of disease, instead of accumulating 
force, these miasms, like other agents of long continued ap- 
plication, would lose their eflicacy. 

It is not impossible, however, that febrile infection may, 
in a certain degree, find admission into the circulation by 
the way of the stomach and bowels ; but, from what has al- 
ready been said, the probability is, that under ordinary cir- 
cumstances, this is not the channel of admission. 

* It has been a received notion among 1 some physiologists, that there was 
a shorter and more direct communication between the stomach and the 
bladder than the circuitous one of the lacteals and blood vessels. For the 
purpose of deciding this question, M. Fodera has performed some inter- 
esting experiments. See the Medical and Physical Journal. In one of 
these he introduced a catheter, with a cork adapted to it, into the bladder, 
and then injected a solution of the prussiate of potass and iron into the sto- 
mach ; as soon as the salt was detected in the urine, (an occurrence which 
in one instance took place in ten, and in another at the end of five minutes,) 
the animals were instantly opened, and the prussiate was found in the blood 
of the vena cava inferior, of the heart, and of the aorta, in the thoracic duct 
and other parts. Should these experiments be confirmed by subsequent 
researches, the difficulty physiologists have encountered in explaining the 
quick transmission of fluid substances from the stomach to the bladder, will 
be obviated, in the demonstration oi the rapidity of the absorption and pro- 
gress of such substances through the ordinary channel of the lacteals or 
lymphatics and the sanguiferous system. In this way, also, might be ex- 
plained the sudden operation of infectious miasms. 



Inquiry into the Seat of Fever, 183 

Fernclius says that what comes in contact with our breath, 
is carried through the lungs to that noble viscus, the heart, 
thence into the arteries, seizing at length upon every part 
of the body ; disordering first the spirits, (spiritus) then the 
humors, (humores) and lastly, the substance of every part. 
(Postremo substantium ipsarum par Hum labifaefat.) 



chapter v. 

INQUIRY" INTO THE SEAT OF FEVER. 

Facts in support of the opinion that the Immediate Cause of 
Fever exists in the Circulating Fluids. 

That the miasms of fever are received into the general 
mass of circulation, we have the strongest arguments for be- 
lieving. We know that when the matter of small pox is 
inserted into the skin, a certain time is necessary for it to 
take effect, and as the skin abounds with absorbents, we have 
every reason to suppose that the variolous, as well as the 
venereal virus is received into the circulation, and commu- 
nicates its properties to the mass of fluids. We can scarce- 
ly suppose that the symptoms which follow the infection of 
the small pox are merely the consequence of an impression 
on the nervous system. Can we believe that an almost in- 
visible atom, birely sufficient to cover the point of a lancet, 
should lie inactive in the body for the space of a week, and 
then suddenly break out, as it were, in an explosion on the 
general system 1 

And if the essential operation of these morbid agents is 
upon the brain and nerves, why are the heart and blood 
vessels excited into action ? Shall we, with Dr. Cullen, con- 
fess our ignorance at the onset of the inquiry, and refer the 
effect to the conservative interposition of the v is medicatrix 
nalura? We know that a change of the nervous does not 
necessarily involve that of the sanguiferous system. We 
frequently see the body agitated with convulsions, or made 



i 34 Inquiry into the Seat of Fever. 

rigid with the lock jaw or tetanus, without communicating 
febrile commotion to the heart and arteries. But although 
the brain, nerves, and muscular fibres of the limbs may be 
violent!)' affected without disording the muscular system ; 
yet the converse of this does not hold equally true, and for 
a very obvious reason : because the blood is the stream and 
fountain of life, and the source of health, nourishment, and 
support to every part of the animal frame. If the blood be 
altered from its healthy state, not only the heart and arte- 
ries, but every part of the general system partakes of the 
disorder. 

That the blood is subject to vitiation, there can be no 
doubt. This I have attempted to demonstrate in another 
work, when treating of scurvy.* 

Suppression of urine, on some occasions, gives rise to the 
symptoms of violent delirium and fever, attended with 
an urinous smell in all the excretions from the patient's body. 
It is remarked by Dr. Ferrier, in his Medical Histories and 
Reflections, as being a well known fact, that in fatal cases of 
ischuria, when the patient dies comatose, the ventricles of 
the brain are filled with a fluid which has the sensible quali- 
ties of urine. Ana it is remarked by Bromfield, that if the 
cause of ischuria is not immediately attended to, a violent 
fever comes on, with retchings to vomit, sometimes coma 
ensues. A temporary relief is frequently obtained by a 
profuse sweat cetnii*g on, which is extremely offensive, from 
its strong urinous smell. t ; ' A sufficient attention," says 
Richerand, " has not hitherto been given^to the symptoms of 
urinous fever, an affection occasioned by a too long reten- 
tion of the liquid in the cavity of the bladder." I have fre- 
quently had occasion to observe that no disease gave better 
marked signs of what physicians call putridity. The urin- 
ous and ammoniacal odour exhaled from the whole body in 
sickness, the yellow greasy moisture covering the skin, the 
great thirst, the dryness and redness of the tongue and 
throat, the frequency and irritation of the pulse, joined to 
the softness and flaccidity of the celular membrane, all indi- 
cate that the animal substance is menaced with speedy and 
prompt decomposition.]: 

it has been previously remarked, that the lymphatics ab- 
sorb indifferently every substance that is presented to then* 
of sufficient tenuity to be received by their orifices ; and 



* ?ee Observations on the Topography and Diseases of Louisiana. 
t BronafieitTs Chirurgical Obs. and Cases, p. 293. 
I Rich era ad's Physiology, p. 95. 



Inquiry into the Seat of Fever. j g 5 

in this way the blood becomes impregnated with the odour 
and quaht.es of substances taken into the stomach, orS 
ed I in resp.rat.on. Mr. Menghiui found by experiment" tat 
be blood of persons who take martial preparations, con 
a.ns more ,ron than it does in an ordinary state. Ad Mr 
Lorry b served , that the urine of a sick person, to whom 
had been exh.b.ted ,ron in a state of extreme comminutioT 

wbT h h e 3 !t iqU0 ? m , nii Was fc ' Jnd tin S ed wifh safi ™ in a woman 
who had used a large quantity of this article.t 

ine use of indigo .mparts its colour to the milk- and! 

mdder and the Indian lig give it a red tinge.t T he 'exhi 

D.t.on ot wormwood renders the milk bitter and thyme 

garhc, and onions .mpregnate it with their odours 6 7 ' 

A cathartic given to the nurse purges the child • and soir 

uous hquors taken by the former, w.ll occasion' ZoJZ 

fcSl C o°n n r Tm '" r hS ,atter; « and H » re!a ^ by Dr. 
,,"" ' 0n c,ed ! ble ""formation, that cabbage and other 
flatulent vegetables, taken by the nurse, hay! occasiotd 

4* ^SZ^^^S^S^§ such «*■*** 

are consequently unfit for the nou i fin^ Uff th bodi ? T? fl^> *"* 
more attenuated matters, and snch as are canaHe of L„ ' ghter anc! 

fie arumsl temperature, pass off by the skin Zl Lt in tleTe "^ " y 
we may discover, when the persons hav- tikeo th. Y . excretions 

these odours, the smell of garlic "onion at a f" j£ S " b ? tances tha < afford 
the essential oils. Substances of a grogs' coll tit ' '"'fr a " d B * of 
.fie animal fluids, as the ^o^Ln^JZ^Z^lf ^J"^ * 
therlost by age the qualities which rendered Z5jS Z™ * ' 
mat economy, and have become too much animated hJ ,D . the ani - 

or which, when taken into the stomach are Zfl/hv 7 , -^ COEtiuua "oe, 
Me of undergoing assimilation, .<XSCS£.^Sffl fj **Wj 
to the kidneys and pass off by urine principally determined 

complished in the lungs, by the combnfa^ - 

the superfluous carbon of the blood, formino- carbomV^ he « lr with 
the function of the skin and that of the kSvc ?h° 1 *** Be,Ween 

that *hen the One is increased t*e other ?s dim X d \ ^ ^°^ SO 
warm climates, and in the summer se son, £* SSS£ ^ f^* 
ere .on of urine, which is smaller in quantity and h h 1 Tt the Se " 
With alkaline salts. It is likewise worthy of remark fh^' aboimdi »S 
the perspiration is more acrimonious til L cold ns nm™ **$!" 

zt » iseases of BMes . This Z^^^SZt^J 

I Ibid Vol VII. de lacte. 

j pl id J 01 ' IJI ; NumaQ,s Chemistry, p. 569. 

II Boerhaave Proelect. sec. 690. Haller El m . PhysioK 



486 Inquiry into the Seat of Fever. 

gripes in the child,* It is said by Boerhaave, that ale, taken 
by a fasting nurse, has in a short time been discharged by 
the breast. t Gmellin states that the milk. of such as are 
salivated, will occasion salivation in a child. 

By slow evaporation, Dr. Hunter discovered globules of 
mercury in the milk of a woman laboring under salivation. 

It is proved by the experiments of Dr. Alexander, that 
nitrate of potash retains its nature and properties after it 
has gone through the circulation.! 

A purgative quality is given to the milk of cows which 
have fed upon hedge hyssop. It is related by Diascorides, 
that the milk of goats that feed on the scammony plant and 
spurge, proves cathartic. We are told by Haller, that field 
fares, by feeding on the berries of the rhamnus catharti- 
cus, are found purgative to those who eat them.§ 

The medicated qualities communicated to the miik by the 
vegetables on which animals feed, was not unknown to the 
ancients ; and such was their conviction of their efficacy in 
this way, that in some diseases they prescribed the milk of 
animals which had fed on vegetables, proper for the cure of 
those diseases. "According to the strength and difference 
of the food," says Crantz, "such is the diversity of the 
milk ; from the former, the chyle is good or bad, bitter or 
sweet ; so also, is the milk from the latter ; as are the injes- 
ta, so is the chyle ; as is the chyle, such is the milk asserted 
to be, and is confirmed by experience. "|| The miik of 
goats which have fed on astringent and balsamic vegetables, 
has been recommended in diarrhoea ; and cows having fed 
upon lettuce, pelatory, madder, or purslain, afford miik so 
imbued with the unchanged qualities of these plants, as to 
communicate their usual effects to such as use the milk thus 
impregnated. IT 

In jaundice the bile is taken into the mass of the circu- 
lating fluids : and Maribilli says the urine of a person labor- 
ing under this complaint, has an intensely bitter taste. In 
jaundice the urine has an orange yellow colour, and com- 
municates the same tint to linen. Muriatic acid renders this 
urine green, and thus detects the presence of a little bite,** 



* Perci vat's Essays, Vol. 1. p. 257. 

t Praelect. & 688. 

£ Experimental Essays. 

§ Med. and Chirurg. Cases. 

[[Crantz M. M.p. 80. 

IT Percival's Essays. 

** Thompson's Chemistry p. 653.. 



Inquiry into the Seat of Fever, \ B7 

The urine is sometimes changed to a bloody hue by taking 
the extract of logwood.* Beets possess the same property. 
It is impregnated with the odour of asparagus, carrots, pars- 
nips, fennel, the oil of savin, turpentine, &c. when these sub- 
stances have been taken ; the smell of the latter is sufficient 
to communicate the odour. A species of fungus is found to 
retain its intoxicating quality, after passing into the urine. f 
The urine is coloured for many hours after taking rhubarb,, 

It is remarked b\ Dr. Russel, of the people of Aleppo, 
who take large quantities of oil, that the same is seen to ex- 
ude through the skin. 

Ichtinophagous birds and hogs fattened upon fish, as they 
are in some places, have a disagreeable fishy taste. The 
odour of carrion is communicated to the flesh of vultures. 

It has been disputed whether the poisonous qualities of 
fish, in certain situations, are communicated to the flesh while 
the animal is alive; and it has been affirmed that the poi- 
son which *^ taken in with their food, transudes through the 
bpwe Is after death ; and that when the animal is dressed im- 
mediately upon being taken, its flesh is free from any dele- 
terious quality. Dr. Thomas, Dr. Buckley and Dr. Hodge, 
are the advocates of this beiief.J It is very doubtful, how- 
ever, whether the opinion of these gentlemen is correct : 
from the analogy of the instances already mentioned, we 
see r.o reason to doubt that poisonous matter taken in with 
the food, may likewise be communicated to the flesh of the 
animals feeding upon it; it is evidently notpoisonous to the 
animals in which it is found, otherwise they could not eat 
the substances which aiford it with impunity ; and from the 
redundancy in which it exists in the stomach and bowels, 
there can be no reasonable doubt of its entering the circula- 
tion, and thence imparting its poisonous qualities to the 
body generally. There is a weed or vegetable which grows 
in the river and creek swamps and low grounds in the state 
of Alabama, of which cattle are very fond, and which so 
thoroughly imbues every part of the animal with its foetid 
and disagreeable odour, that the effluvium is perceptible at 
a considerable distance; the same odour is communicated 
to the milk and flesh, which are thereby rendered offensive 
and unfit for use ; the bones and marrow are also tainted 
with the the flavour of this noisome weed, There is ano- 



* Percival's Essays. 

t Haller Elm. Phys. Vol. VII. de urine. 

% Memoirs of the Lond. Med. Soc. See a,lso, Caldwell's Collection of 
Theses, Vol. II. 



188 Inquiry into the Seat of Fever, 

ther vegetable which grows in the northern parts of Ihii 
state, near the Tennessee river, which imparts so poisonous 
a quality to the milk of cows, as to prove fatal in a short 
time, to such as unfortunately make use of it.* Dr. Mus- 
grave found that by injecting solutions of indigo and stone 
blue into the small intestines of dogs, the lacteals and tho- 
racic duct became coloured with the injection.! 

The bones of the Canada porcupine, during winter, are 
of a greenish yellow, owing, as is supposed, to the bark of the 
pine on which the animal feeds in that season of the year. J 
Globules of mercury have been found in the cells of the 
bones. § 

" A great many substances," says Dr. Fordyce, u may en- 
ter the lacteals along with the chyle, even solids reduced to 
fine powder. When indigo has been thrown into the intes- 
tines of sheep, I have seen, says the Doctor, the chyle ren- 
dered quite blue : now indigo is not soluble in water, but is 
a solid reduced to a very tine powder. So musk gets into 
the chyle, giving it a strong smell, and a great variety of 
other substances of various colours, various tastes, and vari- 
ous smells ; each of them giving colour, or taste, or smell, 
to the chyle. "|| Alkaline mediqifiesj taken internally, 
are discoverable in the urine. 1 his was observed by Sir 
John Pring'e, in a person who had been long under a course 
of Mr. Stephens' medicine. This gentleman's urine had 
not only the volatile smell, but strongly effervesced with the 
common acids. ^ The same observation is confirmed by 
HaJler** and Dr. Percival.tt 

It is said that the plague and other diseases have been 
communicated by injecting the bile, blood, urine, &c. of the 

* In cases of poison, the milk seems to serve as an outlet for the peccant 
matter, and thus the animal escapes uninjured. This has been observed 
in many places in cows giving milk, which remain exempt from disease in 
situations highly destructive to horses and to cows not giving milk. A dis- 
ease originated among the inhabitants of the state of Ohio, from the poison- 
ous quality of the milk of cows, which ran in the woods, aud in uncultivated 
pastures. Those who refrained from the milk, were not affected with the 
disorder. — Med. Repos. Vol. XV p. 92. I am aware, however, that the 
constitutions of quadrupeds are different from those oi the human race, and 
that substances that would prove poisonous and deadly to the latter, are 
eaten by the former with impunity. Thus, I have frequently seen goats 
and cattle feeding with avidity on the leaves of the datura stramonium 
without experiencing an}' ill effects. 

t Philos. Transact. Abr. ch. 4. part 2. p 76. 

:£ Pennant's Arctic Zoologv, Voi. I p. 126. 

$ Haller Elem Phvsol. Vol". I. 

[| Fordyce on Digestion. 

If Pringleon the Diseases of the Army, p. 116. 

** Elem. Physol. Vol. Ill p. 9. 

it Ess. Med. and Exper. Vol. III. 



Inquiry into the Seat of Fever. 189 

deceased into the vessels of the uninfected. From the ex- 
periments of Dr. Deidiere,* it appears that bile taken from 
persons dead of the plague, and either poured into a wound 
made on purpose in different dogs, or injected into the veins, 
never failed, in many trials, to produce in all the symptoms 
of the plague, even the external ones, of buboes and car- 
buncles. One dog, on which the experiment succeeded, 
had been known, for three months before, to devour greedi- 
ly, the corrupted flesh of infected persons, and pledgets 
taken from pestilential ulcers, without receiving any injury. 
It appeared afterwards, from some experiments made by Dr. 
Cousier,! that not only the blood, but even the urine from 
an infected person, infused into (he crural vein of a dog, 
communicated the plague. And in the experiments of Dr. 
Diediere. afterwards made, pestilential bile was swallowed 
by dogs without any injury. J Mr.Colman of the Veterina- 
ry College, assures us that he has produced the glanders, by 
transfusion of blood, both in the horse and the ass.§ 

There is this striking difference between morbid and other 
poisons; the former when admitted into the body, even in 
a \ery small quantity, so small indeed, as at first to give rise 
to no uneasiness, yet after a certain residence develope their 
peculiar influence in the production of disease, and not un- 
frequently in the destruction of animal life. This peculiar- 
ity is owing to the power they possess, of inducing a gradual 
change in the fluids of the body, converting a portion of the 
circulating mass into their own nature. If the portion thus 
assimilated is of a gross consistence and acrimonious quality, 
and not easily perspirable, it is lodged under the cuticle in 
the form of pustules, or is arrested in the lymphatic glands 
of the groin, arm pits, &c. forming buboes and glandular 
swellings. When it is lighter and of a more soluble nature, 
at a certain period it is carried off by perspiration, urine 
and stool. Animal poisons, and the same rule applies also 
to those of the mineral and vegetable kingdoms, on the con- 
trary, possess no such assimilating property, and where the 
quantity or quality of the poison has not been sufficient to 
produce death in the first instance, the patient generally re- 
covers from the effects, which instead of being aggravated 
are mitigated by time : for should the poison not prove fa- 
tal, though not immediately eliminated from the body, we 

* Philos. Transact. Vol. XXXVII. 

t Vide Dissertation Sur Contagion de la Peste, a Toulouse, 1724. 

X Mead on the Plague, Preface, p. 160-1 & 2. 

$ Cox's Phil. Med* Mus. Vol. I. p. 352. 



190 Inquiry into the Seat of Fever. 

know that the system becomes gradually less sensible to ha- 
bitual impressions : so that what at first was capable of ex- 
citing great commotion, shall at length become innoxious. 
The following fact may serve to illustrate this circumstance. 
It is a case related by Dr. Barstow, of Wilkesbarre, Penn. 
of a Mrs. Beenian, who was bitten by a rattlesnake in the 
summer of 1801. After some considerable degree of the 
common consequences of such an event had occurred, she 
at length recovered ; at the full lime of delivery she was 
safely put to bed. The child was apparently healthy ; but 
immediately after allowing it to suck, it assumed the hues 
of a rattlesnake, swelled very much, and soon died. One 
puppy and four lambs shared the same fate from sucking this 
person. The woman all this time was as well as usual, and 
in convalescence from child birth. The fact is 1 confirmed 
by several persons of veracity who were witnesses of this 
phenomenon. Te next child which Mrs. Beeman had was 
not affected by the milk.* 

From such facts would it not appear weak and absurd to 
say that the substances' producing those symptoms and ef- 
fects do not enter the blood in their crude state, and with 
their natural properties ; but that they are digested and form 
an assimilated portion of the chyle ? Which, I would ask, pre- 
sents the greatest difficulty, to suppose that these various 
substances are decomposed on entering the blood, and af- 
terwards recomposed in the excreted fluids of the body, or 
that they remain unchanged, from the time of their being 
taken in, till their final elimination? If their properties are 
once destroyed, for what purpose and by what powers are 
they restored ? It will be difficult for the advocates of an 
opinion so contrary to the evidence of matter of fact to an- 
swer this question. The authority of Boerhaave, Hailer 
and Mead may be adduced to show in opposition to theory, 
that crude mercury, in the form of globules, has been seen 
flowing from the body with the stream of blood. Dr. Lind 
relates, that in the yellow fever the serum of the blood was 
of a yellow tinge, and that a person by curiosity tasting it 
found it bitter.t 

Numerous instances are recorded of the small pox and 
other diseases being communicated to the foetus in utcro. 
The small pox has even been communicated to the foetus 
and the mother remained uninfected, from having previous- 



* Phil. Med. Mug. Vol. III. p. 61. 

t Lind's First Paper on Fever and Infection. 



Inquiry into the Seat of Fever* 191 

\y passed through the disease.* That there might be no 
doubt as to the reality of the disease, the small pox has 
been communicated to others by inoculating with the mat- 
ter of children thus infected. We can scarcely suppose, 
with any degree of probability, that disease in these in- 
stances was communicated through the medium of the ner- 
vous system. Various other cases of a similar nature are 
related by different authors.! The plague has been com- 
municated in the same manner. Dr. Russel gives an in- 
stance of a child born in the fifth month of pregnancy, 
which was covered with buboes. % The same thing has 
taken place in the venereal. § Dr. Zimmerman gives an 
instance of dysentery communicated from the mother to 
the child or foetus, which was born with every symptom of 
that complaint'll And in numerous instances the child has 
sucked the venereal from the infected nurse. 

It can scarcely be doubted that the fever in small pox is 
occasioned by the variolous poison in the circulating fiuids r 
and which nature throws out upon the surface of the body 5 
at which time the fever subsides, but is again excited by the 
absorption of the variolous matter from the pustules. We 
are informed of an Eastern custom by which this secondary- 
fever is prevented, which consists in puncturing the pus- 
tules with a sharp thorn, and absorbing the matter with a 
soft calico rag dipped in warm milk and water. In this 
way, we are told, the natives are frequently employed for 
many hours. " And when it has been zealously persevered 
in," says Holwell, " 1 hardly ever knew it fail of either en- 
tirely preventing the secondary fever, or mitigating it in 
such sort as to render it of no consequence. In various in- 
stances I have seen the pustules in the contiguous kind, 
upon being sufficiently opened, fill again to the eighth time ; 
in the very distinct sort, they will not fill again more than 



* See the cases mentioned by Dr. Morton, Phil. Trans. Vol. XLVI. p. 233 '; 
bv Eh-. Jenner, Lond Med. Review, Vol. II. p. 396 ; by Wm. Forbes, Edin. 
Med. $ Surg. Jour. Vol. III. p. 307. 

t By James Lind. Edinb. Med. & Surg. Jour. Vol. III. p. 55; by Sir Wm. 
Watson and Dr. Van Rosenstein, Philos. Trans. Vol. XLVI. where the 
children are said to have passed through the disease previous to delivery. 
Several cases are likewise mentioned by Dr. Pearson in the Philos. Trans, 
by Mr. Rait. Med. Comment. Vol. XIII. p. 313; Med. & Phys. Jour. Vol. 
V. p. 536, and by Haygarth on Small Pox. 

X Ftussel on the Plague. Gibbon's Decline and Fall of the Rom. Emp, 
Vol. V. chap, xliii. 

} Bell on the Venereal, p. 376. Swediaur on the Vener. Tom. II. p. 10,* 
Foot on the Vener. p. 472. 

Ij Zimmerman on Dysentery, p. IP. 



192 Inquiry into the Seat of Fever, 

once or twice, and sometimes not at all, which was a plain 
indication, that the whole virus of the disease was expelled 
by the first eruption." This well authenticated account of 
the Eastern practice, says Dr. Walker, who quotes this pas- 
sage, puts it beyond a doubt, that different quantities of the 
variolous ichor are generated in the system, in different kinds 
of the small pox.* 

In the mildest cases of the plague, the morbid matter 
shows a particular tendency to accumulate in the glandular 
parts of the body, thus relieving the rest of the system from 
the general diffusion of pestilential virus. 

If in many of the cases of animal, vegetable and morbid 
poisons hitherto mentioned, the substances thus affecting 
the system or circulating fluids, are not discoverable in the 
blood, we are not to infer from this circumstance that they 
do not exist there. The blood itself is a viscid heteroge- 
neous substance, and any extraneous or excrementitious 
matter to be perceptible in this fluid must abound in too 
large a proportion to be compatible with animal life. Thus 
Dr. Seybert injected one drachm of putrid blqod and forty- 
five grains of volatile alkali into the veins of dogs ; " but," 
says he, u the blood gave no signs of alkali." Experiments 
of a similar nature have been repeated by others and with 
the same result. That the alkali existed in the blood in 
the experiment of Dr. Seybert, there can be no doubt ; that 
it was not detected was owing to the imperfection of the 
tests. Experiments and demonstration are certainly the 
best and most infallible guides to improvement; but in the 
present state of our scientific researches, the nicest and most 
important circumstances must evade the grossness and im- 
perfection of our tests. 

* Walker on Small Pox, p. 87. 



Period of Infection, 



CHAPTER VI. 
PERIOD OF INFECTION. 



Of the length of time that elapses from the Period of Expo- 
sure till the appearance of Disease. 

The time which elapses from the period of exposure to 
the full developement of disease, is different in different 
cases ; as depending on the quantity, concentration and vi- 
rulence of the morbific matter received. In many instan- 
ces the attack is instantaneous; in others, symptoms of dis- 
ease do not appear till fifteen or twenty days after expo- 
sure ; and Dr. Haygarth allows that persons may be affected 
as late as the 76 th day after receiving the infection. The 
confluent small pox has beenkuown to appear within twen- 
ty-four hours after exposure to contagion. In the inocu- 
lated small pox, as the quantity of matter inserted is very 
small, and pretty uniformly the same, the disease makes its 
appearance about the same period ; that is, from the seventh 
to the eleventh day after inoculation. A case is mention- 
ed, however, in the Philadelphia Medical Museum, of a 
child in whom the disease did not appear till the expiration 
of a year after inoculation. 

In fevers of the endemic kind, from one to three days may 
be considered as the ordinary time. Mr. Bertrand says, 
that no cases of the plague occurred at Marseilles after the 
thirty-fifth day. At Aleppo, according to Dr. Russel, none 
occurred after the ninth or tenth. But as in these latter 
instances the writers speak of personal contagion, no con- 
clusions can be drawn from their accounts. 

" The air of a sick apartment," says Dr. Lind, " when in 
a close unventilated place, becomes often so highly tainted 
that I have known six attendants affected by it in less than 
twenty- four hours."* The fever which prevailed on board 
the Nottingham East Indiaman, in the year 1766, affected 
those forty men only who had slept on shore in the island of 

* hind on the Diseases of Seamen, p. 83. 
Z 



194 Period of Infection, 

Jolina twenty days before.* From comparing many instan- 
ces, says D>\ Lind, of people who have slept on shore during 
the sickly season, and in consequence of it, who alone have 
been taken ill out of the whole ship's company then lying 
in an open road, it appears that some are immediately seiz- 
ed with sickness or delirium, many are not seized with them 
til! they have been on board for two or three days ; several 
have been only slightly indisposed for the first five or six 
days; and in a' few, the symptoms of indisposition have not 
appeared before the tenth or twelfth day.j " The seeds of 
fever," says Dr. Rush, "when received into the body, were 
generally excited into action in a few days. I met with se- 
veral ca^es in which they acted so as to produce a fever on 
the same dav in which they were received into the system, 
and I heard of two cases in which they excited sickness, 
fainting; and fever within one hour after the persons were 
exposed to them. I met with no instance in which there 
was a longer interval than sixteen days between their being 
received into the body and the production of the disease,"]: 

Besides the quantity of infection received into the body 
in influencing the earlier or later appearance of the disease, 
much will depend upon the state of the constitution dispo- 
sing it. to be more or less easily affected and disturbed by the 
morbific matters. 

After infection has once entered the circulation, it is 
some time before it can be expelled from the system by the 
natural emunctories of the body : during this interval of 
suspense between the time of its reception and the produc- 
tion of disease, it seems to lie dormant, and in many instan- 
ces may be expelled by the excreting organs without the 
production of disease, provided no exciting cause rouses it 
into immediate activity. In an infected and sickly atmos- 
phere, where every breath is loaded with noxious effluvia, 
the body may be supposed to be always impregnated with 
the seeds of disorder ; or, in other words, that it is in a con- 
stant state of predisposition to disease, requiring only some 
occasion of irregularity, exposure, or excess to give activity 
to the dormant infection. " I have remarked," says Dr. 
Lind, "many seamen who belonged to infected ships, after 
having been several days on land, to be seized with the ship 
fever, by over eating, getting drunk, quarrelling, or the like 

* Observations on the Bilious Fevers usual in Voyages to the East Indies, 
by James Badinach, M. D. -Vied. Obs. & Inq. Vol. VI. 

t Lind on the Diseases incidental to Europeans in Hot Climates, p. 194. 
% Rush's Inq. & Obs. Vol. III. p. 86. 



Inquiry into the Theory, #e. 195 

excess, and when they were sent to the hospital I have found 
them covered with petechias. "* 

Fracastorius, treating of the manner in which infection 
enters the body, speaks of the difficulty with which it is 
eliminated as follows : kt With the air which is inspired, the 
mingled semina of contagion at the same time find admit- 
tance ; which, when once introduced, are not expelled with 
the same facility by expiration* since they are aggiu'iuated 
to the fluids and membranes, and sometimes even to the ani- 
mal spirits, and are thus carried to the heart in an inimical 
condition."! 



CHAPTER VII. 



INQUIRY INTO THE THEORY OF FER. 
MENTATION AMD PUTREF ACTION. 



Critical Examination of the Doctrines of Fermentation and 
Putrefaction, in Explanation of the Phenomena of Fever, 

Much has been written about fermentation in diseases, 
and much misunderstanding has arisen on the subject from 
the different acceptations of the term by different writers, 
as well as from the intrinsic obscurity of the subject itself. 
The opinion is of very antiquated date, and among the an- 
cients signified nothing but a vague and indefinite idea of 
an obscure and incomprehensible matter of speculation. 
The following quotation from Etmuller may serve as an ex- 
ample on this occasion. " The eating of summer fruits," 
says he, u frequently causes fevers. Now these are endow- 
ed with a notable property to ferment; the rotten fevers, 
mentioned by the ancients, are only explicable by the doc- 
trine of fermentation; for no living thing can be properly 
entitled to putrefaction, unless by it be meant, a turbulent 

* Lind on Fever and Infection, p. 64. 

t Fracastorius de Contagione, Fo, 7. Feb. 109. Pauli p. 7j. 



•196" Inquiry Into the Theory of 

confused motion, proceeding from (be dissolution of con- 
trary salts; as that of spirit of vitriol and oil of turpentine.'* 
Thus, from what we can gather, Dr. EtmulJer seems to think 
that in the production of fever, fermentation takes place in 
the fluids of the animal body, from the use of fruits, in the 
same way that this process is commenced and carried on in 
a keg of beer. And in the rotten fevers, the fermentation 
js more confused and violent from the dissolution of contra- 
ry salts. 

But such antiquated notions are inconsistent with the 
present improved state of physiological science ; and it is 
certain that in the blood of the living body no fermentation, 
either of the vinous, acetous, or putrefactive kind ever takes 
place, because neither wine, vinegar nor putrid gases are 
ever discovered in it, as the result of such fermentation. 
The different stages and kinds of fermentation may take 
place independent of each other; thus when mucilage 
abounds, the acetous fermentation occurs ; when the sac- 
charine principle predominates, the vinous; and when glu- 
ten is proportionally greatest, the change is that of the pu- 
trefactive fermentation; the latter is that of dead animal 
matter in general : but as the vital principle is incompati- 
ble with either of these processes in the circulating fluids, 
neither of them can be admitted in the explanation of chan- 
ges connected with, and incidental to the living body. 

We have every reason to conclude that morbid poisons, 
in producing disease act by the power of assimilation ; that 
is, of converting a portion of the animal fluids to their own 
nature. This is demonstrated in the small pox, chicken 
pox, lues, &c. : but to relieve, as we are told, the poverty 
of language, this change in the fluids has been called fer- 
mentation ; the word, however, is exceptionable, inasmuch 
as it gives rise to erroneous associations and verbal disputa- 
tions. Mr. Moore, in his Essay on the Materia Medica, 
page 217, speaking of the circumstance under considera- 
tion, says, " It appears more similar to fermentation than 
any other operation in nature ; but there is one striking dif- 
ference, namely, ferments only hasten a process that natu- 
rally would have taken place. For example, leaven quick- 
ens the fermentation of paste, but paste naturally ferments, 
although it requires a longer time than when mixed with 
leaven. But common pus or blood has no tendency to form 
venereal virus." Dr. Adams, in his Essay on Morbid Poi- 
sons, speaking of the doctrine of fermentation, observes, that 
"if this be called reasoning, it will not be difficult to prove 
that a man and an image of rye dough are the same thing. 



Fermentation and Putrefaction. 197 

In fermenting farinacia, does it alter the properties of (he 
fermenting substance what ferment is used. If we express 
the juice of the grape, and add the the yeast of malt to it y 
do we make beer, or vice versa." 

Vander Mye,* Fcrnelius.t Morton. J Ealler.§ Pringle.|| 
and Dr. Gregory, *f[ all mention the offensive smell, stench, 
and fsetor of the fluids of the body and of blood drawn in ma- 
lignant diseases, as the plague, small pox, jail (ever, &c. and 
as a further confirmation of its putridity, notice its fluid and 
dissolved appearance. The same opinion has been embraced 
and advocated by some physicians of the present day, who 
contend that in malignant diseases there is an actual putrid- 
ity in the fluids of the body : others limit the degree of this 
condition, by calling it a strong tendency to putrefaction. — 
It requires no great ingenuity to show that this opinion is 
founded altogether in error ; and that what are called putrid 
diseases, do not owe their origin to a putrid ferment in the 
mass of blood. Though the causes of fevers originate from 
putrefaction, it does not thence follow as a fair inference 
and conclusion, that the system affected by such causes must 
be imbued with a putrid taint, or that the proximate cause 
of those diseases exists in the generation of the putrefactive 
process in the fluids of the animal body. 

Dr. Alexander found,** by repeated experiments, that the 
corrupt and offensive air of a jakes, abounding with the mi- 
asmata of putrefaction, resisted the putrefaction of animal 
and vegetable substances, and preserved them sweet longer 
than the open uncorrupted atmosphere. So, that admitting 
the susceptibility of living and dead matter to be acted upon 
by zimics, ferments, and anti-zimics, to be the same, as the 
idea of a putrid ferment implies, instead of producing a pu- 
trescency of the body, or a tendency to putrefaction, the 
noxious effluvia of decomposition, from their antiseptic pro- 
perty, should impart health to the fluids and soundness to 
the solids. 

In scurvy, which has been called a putrid disease, so far 
are the fluids from being in a state of putridity, that from the 
experiments of Dr. Lind, it appears that blood drawn from 
scorbutic patients corrupts no sooner than the blood of heal- 

* De Morbis Bredensis, p. 14. 

t De Febribus, cap. v. p. 246. 

% Pyretolog. p. 26. 

<) Elem. Phys. torn. ii. p. 85. 

|| On Jail and Hospital Fever, p. 26. 

1T Conspect. Med. } 534. 

** Experimental Inquiry concerning Putrid Diseases. 



198 Inquiry into the Theory of 

thy person? ; and that flesh steeped in the serum of similar 
blood, continued sweet and free from taint, as long as in the 
serum of persons in health.* Besides, to suppose any de- 
gree of putrefaction during the existence of animal life, is 
to presume a condition incompatible with living organized 
matter; such a condition would put a period to our hopes, 
and render the efforts of the physician unavailing; for 
when once putrefaction has taken place, the restoration of 
health is no longer within the reclaiming power of medi- 
cine ; the animal substance is lifeless and disorganized, and 
mixes with its kindred elements. 

Putrefaction is attended with the evolution of a great 
quantity of elastic gases ; if, therefore, this process took 
place in morbid conditions of the body, we should expect to 
find the blood vessels inflated and distended with air: but 
nothing of this kind has ever been observed in diseases. It 
is true the bowels are sometimes inflated in malignant fe- 
vers, but the same thing happens in other disorders, the 
colic for instance, and not unfrequently occurs in healthy 
conditions of the system. 

The offensive odour of the body and the speedy putrefac- 
tion after death have been adduced as arguments in favor 
of a state of putrescency in malignant diseases: but, as I have 
shown in my treatise on scurvy, the first affords no argu- 
ment to the advocates of this opinion, as provj; g nothing 
more than that the excretions are in a morbid state ; the 
same thing is observable in most fevers, and is particularly 
striking in persons laboring under salivation. But in all 
these instances the odour is different from that of putre- 
faction. 

The partial mortifications that sometimes take place in 
malignant fevers, afford no argument in favor of a state of 
general putridity ; they are merely a symptom of universal 
debility, and of the failure of the circulation in remote parts 
of the body, and are as frequent in diseases where equal de- 
bility prevails as in malignant fever. 

Nor does the body putrefy sooner after death from ty- 
phus, than it does in other instances, where the vital princi- 
ple is equally exhausted. It was observed, indeed, by Lind 
junior, Hamilton and Moore, that putrefaction proceeds 
more slowly in the bodies of typhus patients than in others. 
Whatever exhausts the vital principle has a tendency to ac- 
celerate putrefaction. It is from the exhaustion of this 
principle, and not from any putrid ferment present in the 

* Lind on Scurvy, Postscript, p. 513. 



Fermentation and Putrefaction. 199 

blood or any other part of the body that putrefaction is ac- 
celerated after death. It is from this cause, and not from 
the presence of any putrid ferment, that animals exhausted 
in the chase soon become putrid after death ; the same thing 
takes place in those killed by lightning; which occasions 
the total exhaustion of vitality in every part of the system ; 
and as soon as vitality is destroyed, the process of putrefac- 
tion commences. It is from the deleterious property of 
carbonic acid gas, that those who die of asphyxia from sleep- 
ing in a close stove room, soon putrify and undergo rapid 
decomposition. We are told by Baron Larrey, that when 
the asphyxia, from the action of carbonic acid gas, does not 
terminate in this fatal manner, those who have been acted 
upon by its causes are rendered liable to a putrid nervous 
fever, from which they have a tedious and difficult conva- 
lescence. When the disease has been very severe, the skin 
of the most prominent parts of the body falls into gangrene 
and slaughs.* It can hardly be supposed that in such in- 
stances, carbonic acid gas acts as a putrid ferment on the 
living animal bod}. The Samiel wind seems to destroy life 
by suffocation, thereby increasing, as in cases of exposure 
to carbonic acid gas, the carbon in the blood. Chardin re- 
lates that people killed by this wind, seem as if they were 
asleep, and that their limbs are easily separated from their 
bodies, even by handling them. Volney also states, that a 
person killed by the Kamsin wind, remains long warm, 
swells, becomes blue, and is easily torn. 

As the febrile poison is immediately applied to the vascu- 
lar system of the circulating fluids, it is not surprising that 
they should more especially suffer, or lose their tone togeth- 
er with their power and energy of action. It is upon the 
healthy condition of the blood that the health and soundness 
of every part of the system essentially depends. In pro- 
portion as the cause of fever is violent and powerful, in the 
same degree is the vitality of the body more rapidly impair- 
ed and exhausted ; and in proportion to the exhaustion of 
the vital principle is the tendency to putrefaction. The 
flesh of animals that are killed in the ordinary mode retains 
a considerable portion of the vis insita, or inherent princi- 
ple of vitality, even after the body is dressed and dissected ; 
it is this remains of vitality that preserves it sweet and un- 
tainted; as soon as this is extinct it begins to putrefy and 
becomes offensive. The flesh of animals exhausted in the 
chase or by baiting, has lost a considerable portion of the 

* Larrey's Memoirs, Vol. II. p. 129. 



'200 Inquiry into the Theory of 

vital principle, from the violence of the exercise, previous 
to their being killed ; hence the flesh is soft and tender, and 
rans speedily into putrefaction : the same thing often takes 
place in yellow fever, from the almost total extinction of the 
vital principle before the patient has ceased to breathe. In 
those who died of the pestilence in Natchez, in the summer 
and autumn of 1 823, the muscles and flesh of the* body were 
so tender and putrid that they separated from the bones up- 
on handling them, so as to render it impossible to lay out 
the corpses in the usual manner; and the only way in 
which the bodies could be managed, was to lift them into 
the coffins in the sheets they died in, as soon as they had 
ceased to breathe: the whole. body appearing to be com- 
pletely putrid and gangrenous immediately after death. 

Nor is the dark colour and dissolved state of the blood 
any sign of putridity ; it only indicates that Ihis fluid is in a 
morbid condition. The blood in typhus resembles, in ap- 
pearance and consistence, that of the vena portae, which 
from experiments is found to putrefy more slowly than that 
which has just circulated through the lungs : analogous to 
this is the blood of those animals that remain torpid during 
the winter, and which becomes thereby highly carbonized. 
" I am assured," says Dr. Maelurg, u that blood drawn from 
animals which sleep during the winter, while they are in 
their torpid state, does not coagulate at all And yet all 
the circumstances of the vis vitce, seem to be present here 
in excess.''* From experiments related in the Annals of 
Chemistry, it appears that hydrogen gas injected into the 
jugular vein keeps the blood liquid, and imparts to it an inky 
blackness.! "It is well known, 1 ' says Dr. Mitchill, "that 
hydrogen gas obtained from animal substances, contains a 
quantity of carbon in solution ; so that venous blood owes its 
dark hue and its disposition to fluidity, to the commixture of 
a quantity of carburetted hydrogen. J This applies more 
particularly to the venous blood of persons in health, but, as 
will be hereafter shown, a mixture of alkali with the blood 
possesses the same property of rendering it dark colored 
and fluid. 

The excessive redundancy of bile, which frequently oc- 
curs in endemic fevers, has also been accused both as a re- 
sult, and likewise a promoting cause of putrefaction; but 
the truth is, this secretion is a powerful antiseptic, not only 

* Maelurg- on Human Bile. 

t Annalesde Chimie.tom. v. p.26S. 

£ Mitchill's Letter to Havens. Tracts on Seplon, p. 90. 



Fermentation and Putrefaction. 201 

ting putrefaction in other substances, but also, of itself 
remaining longer free from putridity than any other fluid of 
the body. It is not unusual, at farm houses in the country, 
to see gall bladders with their contents, which have hung 
up for months, as remedies of domestic use, free from cor- 
ruption, and the fluid at length becoming inspissated to a 
solid consistence, without having undergone any degree of 
putrefaction. We are not much surprised that the moderns 
should have embraced an opinion favorable to their hy- 
pothesi? of diseases, since similar causes led Boerhaave and 
'Senac into error. " Even the learned Dr. Haller has quoted 
from Mr. Gaber an experiment to prove that the bile begins 
to stink in a cold place, within two hours after death. — ■ 
Nothing can be more clear than the presumption that the 
force of imagination and the prejudice of opinion had, in 
this instance, previously affected the olfactories of Mr. Ga- 
ber with an offensive odour, since without the assistance of 
these powerful auxiliaries it would have been impossible for 
him to discover it in the bile. Dr. Maclurg, who notices 
this circumstance, observes, " But when I find that bile ta- 
ken out of the body, which is yet warm, and bile which has 
lain in the bladder three or four days after death, have ex- 
actly the same properties, and, particularly, are both firmly 
coagulated by vegetable acids, I am inclined to consider Mr. 
Gaber's case as somewhat singular."* " The bile," says 
the same author, in Experiment 36, "had lain, to my 
knowledge, thirty days in the dead body ; and the gall blad- 
der was taken out; there was a very offensive smell in all 
the abdominal viscera, yet this fluid, being poured into a 
phial, and closely stopped, acquired a sweet smell, which 
continued some days before the putrid fcetor began." And 
we learn from the same experiment, that it had a greater 
effect, than so much water in retarding putrefaction, and 
making it less offensive. 

It is well known that bitters act as antiseptics upon dead 
animal and vegetable matters; and that the bile, from its 
bitterness, should possess this property in an eminent de- 
gree, is agreeable to the general analogy of nature in other 
instances ; the greater wonder would be, that it should 
prove otherwise ; and nothing but the circumstance of its 
redundancy in fevers of supposed putridity has given rise 
to an opinion so erroneous' as that of the putrescent quality 
of the bile. 

: VTaclurg's Experiments on Human Bile, p. 61. 
A % 



202 Inquiry into the Theory, fyc. 

From all which it would appear that the doctrine of a 
putrid tendency in the animal body receives no countenance 
and support from any state and condition of the bile. Since 
putrefaction is incompatible with life, is it not absurd and 
unphilosophical to talk of a tendency to an event which, in 
the nature of things, never did nor ever can happen in the 
living body? Was ever life destroyed by a tendency to pu- 
trefaction ? We are told, moreover, that the fluids of old 
persons are more disposed to putrefy than those of the 
young; but more accurate observation informs us, that the 
flesh of young animals is somewhat more prone to putridity 
than that of old animals :'* and it is important to remember 
that an acrimony of the fluids is very different from a state 
of putrescency. That the fluids and excretions of the body 
are more acrimonious in the aged than in young persons, 
is a physiological truth, confirmed and proved by general 
observation: such an acrimony, however, has no connexion 
with, or dependence upon, any putridity or putrid tendency 
of the system. This subject may, probably, be correctly 
illustrated, by saving, that the fluids and solids of old persons 
are more highly animalized than those of the young; hence 
their acrimony and disagreeable odour; in the same way as 
takes place in carnivorous animals, whose bodies and fluids, 
from the exclusive use of animal food, acquire an acrimony 
and rancidity, similar to that which naturally occurs in ad- 
vanced lifcin the human constitution. Hence it probably 
was, that the flesh of all quadrupeds except those of the ru- 
minating kind, which live exclusively upon vegetable food, 
was prohibited to the Jews by the Levitical law of the Old 
Testament : for, inasmuch as the flesh of these beasts is 
already too highly animalized, the use of it would produce 
a hurtful excess of this disposition in the human system. 

Life is frequently destroyed by fewer, and, as before re- 
marked, it may be said that every thing that has a tendency 
to produce death, has also a tendency, in one sense, to pro- 
duce putrefaction ; for death is the commencement of this 
process; and whether life has been terminated by a fever, 
the Samiel blast, a fit of apoplexy, or a fracture of the head, 
there is an equal tendency to putrefaction ; but to say that 
death is produced by a putrescency of the fluids, is anticis 
pating a change compatible only with death itself. 

* Med. Comment. Vol. II. p. 142. 



Proximate Cause of Fever, 2^3 

CHAPTER VIII. 
PROXIMATE CAUSE OF FEVER. 



Of the Proximate Cause of Fever, or the Operation and Ef- 
fects of the Remote Causes, 

Since the external circumstances, hitherto considered, in 
chapter 1st, derange the animal economy and disorder the 
health of those who are exposed to them, the question ari- 
ses, what is their manner of operation in the production of 
disease ? The question is important and interesting, inas- 
much as it involves in its consideration the functions of the 
animal economy, so far as they are concerned in the transi- 
tion of the system from a state of health to that of disease, 
together with a knowledge, more or less perfect, of the im- 
mediate cause of febrile epidemics. 

It is evident that no rational indications of cure can be 
founded without a knowledge of the proximate cause. If 
we are, therefore, ignorant of this fundamental and rational 
guide, our practice must be, in a great measure, the mere 
quackery of empiricism, without object or design, unsup- 
ported by truth, and fundamentally erroneous. By a re- 
moval of the proximate cause we cure the disease, and un- 
til this cause is removed, our efforts must be unsuccessful. 
Thus the theory of scurvy, as I have in another work at- 
tempted to show, teaches us to consider the proximate cause 
of this disease as consisting in a morbid alkalescency of the 
fluids of the body, and our plain and obvious indication is to 
correct this alkalescency by the use of acids and acescents. 

The predisposing causes of fever are such as debilitate, 
and produce a greater or less disorder in the functions of 
the animal body ; and one of the most frequent and power- 
ful of the exciting causes is cold. The obvious operation of 
all these morbid and debilitating agents, is the suppression 
of the perspiration, and provided no other causes have ope- 
rated on the body but those of the simply depressing and 
exhausting kinds and the subsequent application of cold, the 
fever will be a catarrh or synocha. For agreeably to Sancc 



^04 Proximate Cause of Fever. 

torius, "Whenever nature is disturbed in the business of 
perspiration, she soon begins to be defective in many more 
of the animal functions.' 5 * When we consider that five 
eighths of the meats and drinks taken in go off by insensible 
perspiration,! we may easiiy imagine that the retention of 
so great a proportion of the[ excrementitious matters, 
even for a short time, must be productive of considerable 
disorder to the system. It is observed by Hoffman, that 
nothing tends more to vitiate the bile, render it impure, or 
load it with caustic salts, than the usual perspiration on the 
surface of the body being checked : and that such an ob- 
struction takes place in fever, every circumstance leads us 
to believe. We have previously noticed the arguments in 
proof of the morbific miasms being received into the system ; 
and remarked, that in many instances their operation is so 
powerful as to occasion instant death ; that when less sud- 
den and violent the symptoms of derangement are protract- 
ed for a longer or a shorter time, until the natural and vital 
functions of the body are again restored. 

We have formerly noticed the results of decomposition 
as consisting principally of ammonia, phosphuretled, sul- 
phuretted, and carburetted hydrogen gases; all of them 
highly injurious to animal life. The phosphuretted and 
sulphuretted hydrogen gases, however, from their not re- 
maining long perceptible to the sense of smell are probably 
not very permanent; but the carburetted hydrogen is con- 
stantly disengaged from all decomposing vegetable matter, 

^Medicin. Stat. Sec. ii. Aph. xxxv. on Air and Water. As causes of 
suppressing perspiration, Sanctorius mentions the following circumstances, 
cold, damp and humid air, swimming in cold water, gross viscid food, and 
neglect of exercise. {Aph. 67) He observes in another place, that cold, 
windy, or wet air lessens perspiration. {Aph. 200.) "Grief," says he, 
"does intrinsically prevent its discharge, and a foul air especially." {Af- 
fections of the Mind, Aph. 14.) "They who go to bed with grief perspire 
thereby less in the night, and the following day their bodies will be found 
heavier." He farther remarks that if through any error, a pound of perspi- 
rable matter is detained in one day, nature is generally three days in dis- 
charging it. To which his commentator, Quincy, gives the follcwirg ex- 
planation, after observing that experience confirms the truth of the aphor- 
ism, he remarks, "upon taking cold, as it is usually called, which is nothing 
else than a lessened perspiration, it is seldom less than three days before 
the inconveniences arising from it are removed ; and by that time the body 
either gets quite rid of them, or is seized with the usual symptoms of an 
acute fever, of which, unless removed by some evacuation that carries oft* 
the overcharge, nobody can see the consequences." Sanctorius elsewhere 
remarks, that " an obstructed perspiration in summer disposes to malignant 
fevers; whereas, in winter it makes but small alteration. For bodies are 
*nore subject to acrimony or sharpness of the perspirable matter in summer 
than in the winter season." (Qn Air and Watery Sec. ii. Aph. 35.) 

t Sanctor. Sec. i. Aph. 6. 



Proximate Cause of Fever: 205 

and together with ammonia probably constitutes the chief 
ingredient of marsh miasmata. 

From the striking analogy existing between scurvy and 
typhus, we have reason to conclude that they are allied in 
their nature : the poison of the one being more inactive, and 
more gradually accumulated in the sjstem, gives rise to 
symptoms of a less acute nature. Between typhus and 
scurvy, however, the resemblance is striking, and so closely 
do they approximate in their character and appearance that 
they are frequently confounded with each other; insomuch 
as sometimes to render it difficult to decide upon the nature 
of the epidemic. The plague and scurvy have many symp- 
toms in common, and frequently alternate, or prevail at the 
same time, more especially in camps, or besieged places. — 
They both originate where famine, bad provisions, noxious 
exhalations and filth prevail. The chief difference seems 
to be, that in scurvy the noxious matter of disease is princi- 
pally taken in by the stomach with the food, and in the plague 
from the atmosphere by the lungs. In scurvy, the fluids 
are manifestly alkaline ; and from analogy we infer a simi- 
lar condition, both in typhus and in endemic fever.* A 
tendency of this nature is, indeed, observable in all fevers 
which are of long continuance. It is the natural effect of 
the suppression of the perspiration and defect of nourish- 

* In my treatise on scurvy, I have mentioned the following facts, in il- 
lustration and proof of the morbid redundancy of alkali in the fluids of scor- 
butic patients. 

" 1st. The urine turns vegetable blue infusions to a green colour: (and 
we are informed by Johnson, that the blood of a scorbutic patient had an 
alkaline taste, and changed the svrup of violets green. {Animal Chemistry, 
p. 95.) 

2d. The blood is dissolved and more thin and fluid than natural. Ac- 
cording to the observations of Lord Anson's surgeons, Messrs. Ettick and 
Allen, in the dissection of scorbutic subjects, the blood in the veins was so 
entirely broken, that by cutting any considerable branch the part to which 
it belonged might be emptied of its black and yellow liquor. 

3d. The fleshy or fibrous parts of the body are relaxed, soft and easily 
lacerated. 

4th. The water contained in the thorax and abdomen, found upon dis- 
section, possesses such a high degree qf acrimony and causticity, as to ex- 
coriate the hands upon coming in contact with it. 

5th. The blood of scorbutic patients, by the admixture of lemon juice, 
becomes somewhat lighter, and on the addition of nitre and vinegar, it be- 
comes of a florid red ; the same appearance takes place with nitre and le- 
mon juice. By volatile alkali the coagulum is turned black, and is again 
rendered florid by the addition of nitre in the juice of lemons and in vinegar. 

6th. The exhibition of alkalies produces a scorbutic habit of body. 

7th. It is well known that vegetable acids and acescents are the most 
powerful and infallible antidotes and remedies for scurvy." See Observa- 
tions on the Topog, & Diseases of Louisiana, p. 72. 



L 2Q& Proximate Cause of Fever* 

ment to render all the fluids of the body more highly ani- 
malized and acrimonious, and to increase their natural ten- 
dency to alkalescency. This is remarkable in those who 
are starved to death. Now in fever there is a constant wast- 
ing of the substance of the body, and defect of nourishment, 
which are equivalent to starvation in their effects upon the 
system. In animals starved to death, there is an accumula- 
tion of bile in the gall bladder, in the same manner as takes 
place in bilious fever, and from similar causes, viz. an acri- 
monious state of the fluids, which it is, in a great degree, 
the function of the liver to correct and prevent, as far, at 
least, as is consistent with the limited powers of its opera- 
tion. It was supposed by Morgagni, that the distention of 
the gall bladder, observed in cases of starvation, was owing 
to the empty state of the stomach, freeing the receptacle of 
the bile from its ordinary compression. This opinion, how- 
ever, seems to be erroneous ; for Haller found both the sto- 
mach and the gall bladder full of biie in an animal that had 
heen starved to death. * And another observer has remark- 
ed a vomiting of bile, and jaundice among the consequences 
of privation of food.t It is well known, that in jaundice, 
the bile, from being obstructed in its natural outlet, is ab- 
sorbed and diffused through the system, and hence a con- 
siderable degree of vitiation and dissolution of the blood 
must necessarily ensue. Where the jaundice has been of 
long standing, the body sometimes becomes covered with 
itching scorbutic eruptions, and haemorrhages take place 
from different parts of the body. " In a high degree of 
jaundice," says Dr. Huxham, " haemorrhages often burst 
forth from all parts of the body ; as I have frequently seen, 
and which could not be restrained by any kind of medicines ; 
nay, you no sooner stop the flux in one place than it bursts 

* Phys. L. xix. s. 2. 

f Fontan. Dissert. Anat. p. 39. Dr. Langrish, in his Modern Theory and 
Practice of Physic, has related some experiments which go to show the 
chemical and morbid condition of the blood in inflammatory fever. Having 
distilled two separate portions of the blood, drawn from people in inflam- 
matory fevers, he found the quantities of volatile salt and oil, which came 
over in the receiver to be very near double to what they were in (he like 
portion of the blood drawn from persons in perfect health ; and in like man- 
ner, when he analyzed the urine, he found that as the fever went off, and 
the saline and earthly particles were in a good measure discharged by this 
srotlet, the quantities of volatile salt and od which came over in the distilla- 
tion, were about double the quantity found in the urine made while the fe- 
ver was going on, and while these irritating matters remained blended with 
the general mass of the circulating fluids ; the urine becoming more and 
more impregnated with salt and oil, in proportion to the abatement of the 
beat, and of the other distressing symptoms. 



Proximate Cause of Fever. 207 

out in another.'** "Many years ago," says the same au- 
thor, " a robust gentleman, who drank hard and indulged 
much in spirituous liquors, fell into a severe jaundice, from 
which, however, he would have escaped, if he had regularly 
conformed to the rules I gave him. But he did not; and 
because his gums bled, and his teeth were black and foul 
with scurvy, applied himself to a tooth doctor, forsooth, 
who, rubbing his teeth and gums strongly, brought on a hse- 
morrhagy, of which he died in sixteen hours. "t Dr. Tissot 
mentions the case of a patient, who having imperfectly re- 
covered from a bilious fever, with an obstruction of the* 
liver, by afterwards taking soap pills, was affected with anx- 
iety, oppression, jaundice and dropsy, which ended in death, 
to which he thinks the pills contributed. J 

Analogous to these causes in producing vitiation of the 
blood, is the action of miasmata received into the mass of 
circulating fluids, which have a tendency to increase their 
natural aikalescency. Even the serum of healthy blood 
contains soda in an uncombined state ; and it appears to be 
owing to the solvent power of this alkali, says Johnson, that 
the albuminous portion of the blood is preserved in a state 
of fluidity. § But this mineral alkali is more especially abun- 
dant in the excreted fluids of the body: As we know not 
what constitutes the difference between soda and ammonia, 
and as they both agree in their general properties, it is pro- 
bable that by some slight change effected in the course of 
the circulation and by the secretory organs, the one may be 
converted into the other: however this may be, the pre- 
sumption is, that when abounding in undue proportion they 
mutually aid the operation of each other in their morbific 
influence upon the body. During the summer season, in 
warm and unhealthy climates and situations, the principles 
of ammonia, nitrogen and hydrogen, are continually receiv- 
ed into the lungs by respiration ; nitrogen, we have already 
remarked, forms a permanent portion of the atmosphere, 
whilst hydrogen is continually extricated from decomposing 
animal and vegetable substances. And it has been already 
stated that from the observation of Goodwin and the expeF- 



* Huxham on Epidemics, Vol. I. p. 191. 

t Ibid. 

^ Tissot. Essay on Bilious Fever, p. 22. 

$ Chemical analysis discovers the following ingredients in the blood ; 
water, albumen, gelatin, hydro-sulphuret of ammonia, soda, sun-phosphate 
of iron, phosphate of soda, muriate of soda, phosphate of lime; besides a 
small portion of benzoic acid, which has been detected hy Proust. Thomp- 
son's Chemulry, Vol. II. p. 662. 



208 Proximate Cause g/ Fever. 

irnents of PfafF, nitrogen gas is consumed in considerable 
quantity in the lungs, and by meeting with the hydrogen of 
decomposition, received also in respiration, an alkaline com- 
pound is formed pernicious and destructive to animal life. 
We also know that ammonia itself is formed in considerable 
quantity during the process of decomposition ; .and, being an 
aeriform substance, may be received into the circulation 
from the atmosphere which surrounds us. 

As nitrogen constitutes the principal and striking differ- 
ence of animal from vegetable matter, we see the necessity 
of this element as an indispensable requisite in the economy 
of nutrition, in assimilating vegetable food, thus rendering it 
more animaiized, and thereby accomplishing the purposes 
cf nourishment and growth to the body. As vegetable food 
consists in a redundancy of carbon, which is given off in the 
lungs, and in a deficiency of nitrogen, which is supplied from 
the atmosphere in respiration in animals purely herbivorous, 
and partly from the food in those which feed upon the flesh 
of animals, as man, we can perceive how these necessary 
principles of our bodies are adjusted in an atmosphere pure 
and unccntaminated. But in warm climates and unhealthy 
seasons there is constant danger of the animal process go- 
ing too far. To correct, and in some measure to obviate 
the injurious excess of this tendency are the offices and ob- 
jects of the various excretions, and more especially the se- 
cretion and excretion of bile. This we infer from several 
considerations, and particularly from the abundant forma- 
tion of the biliary fluid which takes place in warm climates, 
and in the hot and unhealthy season of the year. 

There appears to be a considerable analogy and depen- 
dance between the functions of the luns;s and of the liver, 
and the presumption is, that they mutually assist each other 
in the purification of the blood. To remedy or prevent 
the morbific tendency in the system, arising from the want 
of respiration in the foetus we find the liver disproportiona- 
b!y large. Fourcroy was of opinion that the blood as it 
circulates through the mesenteric, splenic, and hepatic arte- 
ries, and afterwards into the divisions of the vena portarum, 
undergoes great changes in its nature ; whether as physiolo- 
gists say, it dissolves and takes with it some of the fat of the 
abdominal viscera, which is scarcely possible, or rather on 
traversing these different regions very gradually, the car- 
bon it contains unites with the oxygen, which, as it were, 
has only been interposed between the molucles of the com- 
ponent parts, during the respiration in passing through the 
lungs ; and consequently being a long time in regaining that 



I 



Proximate Cause of Fever. 209 

viscus, it assumes a fatty character, from the superabund- 
ance of hydrogen, which it communicates to the organs it 
nourishes and supports. It has been said that if this be the 
effect in man and quadrupeds, whose respiration is so per- 
fect, in the vessels through which the blood circulates with 
rapidity, it ought to be infinitely more marked in those ani- 
mals which are able to live a long time in the mud, or most 
infectious filth, without breathing, and in whom, where res- 
piration does take place, it is only in a very limited and im- 
perfect manner, from the smallness of their respiratory or- 
gans, and from the consequent admission of a very small 
quantity of air, and which cannot be intimately united with 
the humors for a long time after its reception, from the 
slowness with which the fluids of such animals circulate 
through the body. Hence these amphibious animals are 
more or less soft and cartilaginous, pale and even colourless 
throughout their composition, have very little sensibility, 
and are without agility. Fourcroy has drawn these conclu- 
sions from the component parts of the bile ; from sometimes 
finding traces of oil from teazing or cutting the human 
liver, and that of quadrupeds; from the liver of the ray 
containing more than half its weight of oil perfectly form- 
ed ; from certain parts of the lower belly, in diseases of the 
liver, taking on a fatty character, and becoming white, or 
rather grey, like the liver of the ray ; from the livers of 
flying animals, particularly of birds exposed to a high tem- 
perature and fed on milk, taking the same character; and 
from the size of this viscus in amphibious animals when 
compared with others, and the liquidity and oiliness of their 
brain, which may be attributed to a very limited respiration. 
Bile, like soap, is decomposed by acids ; when agitated 
in a phial, it forms a lather like soap and water; and its 
saponaceous property is demonstrated in purposes for which 
it is employed by scourers, to remove spots of grease from 
cloth. A considerable portion of the bile consist of mucil- 
age, combined with a bitter resinous principle, soluble in 
alcohol, together with soda. The combination formed by 
the addition of vinegar to bile, is a coagulum. This mixture 
filtered and evaporated, affords a neutral salt, formed by the 
acid that has been employed, and soda. For this elegant ex- 
periment, proving the existence of soda in the bile, chem- 
istry is indebted to M. Cadet. The matter that rests on the 
filter in this instance is thick, viscid, very bitter, and highly 
inflammable. This precipitate is a substance similar in its 
nature to resin. " The action of acids on the bile,'' saya 
Fourcroy, "shows, therefore, that this suhstauce is a true 



2 i Proximate Cause of Fever. 

soap, formed of an oil, nearly of a resinous nature, in union 
with soda." The bile combines readily with oils, and takes 
them up, as well as soap from stuffs. The fluid is entirely 
dissolved in alcohol; which separates from it the albumin- 
ous matter. The tincture of bile is not decomposed by 
water ; which shows this substance to be a true animal soap, 
equally soluble in aqueous and spirituous menstrua. iEther 
very readily dissolves it. Vinegar decomposes the bile as 
well as the mineral acids. The liquor, filtered and evap* 
orated, affords acetate of soda in regular crystals. From 
these several facts, it follows, says Fourcroy, that the bile 
is a compound, consisting of a good deal of water, a pecu- 
liar aroma, an albuminous mucilage, a particular concresi- 
ble oil, and carbonate of soda.* Dr. Saunders thinks it 
doubiful whether the bile really forms one of the constitu- 
ent parts of the chyle or not. If, however, all or any of the 
component parts of bile do contribute to chylification, no 
traces of their presence can be discovered from the sensi- 
ble properties of the chyle. From the constipation of the 
bowels which takes place in jaundice, Dr. Saunders consid- 
ers the bile as a natural cathartic. " It is probable, there- 
fore," says he, " that even admitting the bile to contribute 
somewhat to the digestion and assimilation of our food, its 
principal office is that of a natural habitual stimulus to the 
intestines, keeping up their energy and peristaltic motion." 
It has been further said, that by virtue of its alkaline nature 
it corrects acidity, resists fermentation, and by its bitter qua- 
lity retards the putrefactive process. That it does assist in. 
the assimilation of the food is probable, from the circum- 
stance of the economy, by which it is provided that the bile 
flows into the duodenum at the time of chylification, there- 
by correcting any undue acidity which may exist, and by 
the admixture, of its oily and mucilaginous portions assisting 
the animalization of the chymous mass. 

Notwithstanding these various uses and properties of the 
bile, there is every reason to believe that it is, to a consid- 
erable degree, excrementitious, from the considerations 
hitherto maintained, as well as from the quality of the blood 
from which it is secreted. We find that nil the other secre- 
tions of the body take place from arterial blood : whereas 
the bile is secreted from that which has undergone the last 
degree of vitiation which it is capable of receiving in the 
living animal body; after having fulfilled the purposes of 
nutrition, and contributed to the other secretions of the 

* Fourcroy's Chemistry, Vol. II. p. 12-13-. 



Proximate Cause of Fever-. 211 

gystem, and when it is no longer fit for the general purposes 
of the animal economy, it is returned to the centre, black, 
grumous, and loaded with impurities. The blood of the, 
vena portae is, physiologically speaking, in the highest degree 
animalized, possessing a large portion of carbon and hydro- 
-gen, or carburetted hydrogen in a concrete state, together 
with an undue portion of alkali, or its principles. As the 
lungs are not adequate to the purification of the blood from 
the injurious redundancy of these matters, it undergoes a 
previous and partial purification in the liver, by which such 
pads as the more delicate function of the lungs is unqualifi- 
ed to eliminate, are separated from the mass of blood ; and 
after having undergone the last degree of purification in the 
lungs, is again fit for the various purposes of nutrition. 

Besides, the liver is too voluminous to admit the supposi- 
tion that its function is merely that of a secretory organ, 
seeing it far exceeds the size of any other gland in the body ; 
and in animals of limited respiration, its dimensions are 
greatly increased, to supply the defect in the function of the 
lungs. The carbon and hydrogen seem principally to give 
the dark colour to the venous blood, while its fluidity is 
derived from the soda. In circulating through the liver, 
these principles are separated from the blood, and the car- 
bon and hydrogen uniting, form the oily substance, which 
combining with the alkali, a liquid saponaceous fluid is pro- 
duced with the characteristic properties of bile. Johnson^ 
speaking of the excrementitious nature of the bile, observes, 
11 Hence arises the necessity of this fluid being made with 
constancy and regularity, for the integrity of all the func- 
tions, and the reason of its existing in all animals, and of its 
being as necessary as the function of the lungs during respi- 
ration. In those animals whose respiratory organs are small 
in comparison to their bodies, and where the carbon and 
hydrogen must be in large quantity in their blood for the 
want of proper evacuation, the liver is remarkably capa- 
cious, and the secretion of bile great in proportion, by 
which means these substances are evacuated, and these ani- 
mals adapted to their mode of life." It is in this way that 
these two viscera assist each other. To this circumstance of 
the bile being in a great degree excrementitious, may be 
ascribed several other properties, viz : its nauseous and dis- 
gusting smell and taste. It appears from the experiments 
of Fourcroy, that the oily part of the bile is nearly in the 
state of spermaceti, but preserving its fluidity during a state 
of health. When, however, this matter is too abundant to 
remain in solution in the bile, it become crystalized, form- 



212 Proximate Cause of Fever. 

ing calculi in the gall bladder, which, on analysis, evi- 
dently appear to owe their foundation to this oily concres- 
cible matter; which being retained either in the pores or 
parenchymatous substance of the liver, often proves the 
source of several of its diseases. Thus, from the most im- 
pure blood, and such as many have considered strongly dis- 
posed to putrescency, a fluid, the most antiseptic of any in 
the body, is secreted. What, effect the bitterness of the 
bile may have in resisting the putrefaction of the fceeal resi- 
duum in the bowels, we cannot positively say ; but we know 
that the foeces undergo a degree of putrefaction in the large 
intestines, and it is possible that the bile may check and re- 
tard this process. This, however, is not considered as an 
established fact, unless it should appear that, the excrement 
of a jaundiced patient, where the bile is excluded from the 
bowels, is more putrid and offensive than that of a person 
in health. 

Whatever has a tendency to increase the excrementitious 
quality of the fluids beyond the degree consistent with 
health, must disorder the functions of the system, and pre- 
dispose to, or produce disease. Such a tendency I conceive 
to be occasioned by the noxious miasmata generated in warm 
climates, and during the summer season in more northerly 
latitudes. As previously remarked, both ammonia and its 
principles are disengaged from decomposing animal and 
vegetable matters, and being received into the body increase 
the alkalescency of the animal fluids. Now, every thing 
possessing this property must favor the production of that 
state of the blood which disposes to the increased secretion 
of bile \ and we consequently fin£,"as a characteristic of the 
fevers of warm climates, that there is always an undue 
quantity of the biliary secretion. This circumstance was 
remarked as early as the days of Hippocrates,* and has 
since been confirmed by the general observation of all ex- 
perienced physicians.! This substance, however, deviates 
in disease from the healthy state, not only in quantity, but 
also in quality and consistence ; being exceedingly acrid 
and alkaline, and frequently of the blackness and consist- 



* Hec enim anni tempestas aestas aestuosa est, et corpus bili majis abun- 
dat, gravitates etiam lumbos et genua infestant, calores aboriuntur, and 
venter torminibus torquetur. De Sahib. Victus Ralione. 

t The influence of the season in changing the quantity as well as'tbe 
quality of the bile, has been observed cot only in the human, but also in 
the brute creation. " I have been assured," says Dr. Ryan Robison, " by 
a very knowing butcher, that animals have the least bile in January, and 
most in July. 1 ' Robison on the operation of Medicine, 



Proximate Cause of Fever. 213 

ence of tar or molasses : evidently showing a great redun- 
dancy and excess of the principles which afford it in the 
mass of blood. 

It is remarked by Hippocrates,* that during the summer 
and autumn, the atrabilis, or black bile, is thick and abun- 
dant, as depending on the condition of the blood. And 
Prosper Alpinus, speaking of the fatal pestilential fevers 
which raged in Alexandria during the autumnal months, 
mentions, among others, the following symptoms : On the 
first day, many were affected with a bilious vomiting, the 
body was in a continual state of restlessness and agitation, 
with great oppression at the stomach. In many, the evacu- 
ations by stool were liquid and bilious.! 

Mitchill, in his account of the yellow fever of Virginia, in 
1741 and 42, says, " The gall bladder appeared always of 
a deep yellow, but was full of black, ropy, coagulated atra- 
bilis, which sort of substance likewise obstructed the 
porus biliarius and ductus cholidochus. This atrabilis was 
hardly fluid ; but, on opening the gall bladder it retained its 
form and shape without being evacuated, being of the con- 
sistence of thin extract, and with all, glutinous and ropy, 
like soap when boiling.]: Dr. Cleghorn, in his account of 
the diseases of Minorca, relates that he examined the bodies 
of more than a hundred who had died of tertian fevers, and 
that, he constantly found the gall bladder, as well as the sto- 
mach and intestines, overflowing with bilious matter. § The 
copious and excessive vomiting of bile in the yellow fever 
of the West Indies is well described by Hiliary|j and Bisset.1I 
Lancissi and Guidili examined the bodies of those who had 
died of bilious fever, and found the cystic bile black, and 
sometimes concrete, and much vitiated and altered from its 
healthy state; and the liver of a brown colour. ** Dr. 
M'Lean in his inquiry, speaking of the redundancy of bile 
in the fevers of the West Indies, informs us that in almost 
every dissection he had either seen or heard of, the liver 
has been found somewhat enlarged and tumid, and the gall 
bladder commonly distended and full.tt Dr. Davis, in the 



*Lib. de Natur. Horn. sec. 14. 
t Alpin. de Medicin. Egypt, lib. i. cap. xiv p. 5l. 
$ Cox's Phil. Med. Mus. Vol. I. p. 4. 
$ Diseases of Minorca p. 165. 
|! Observations on the Diseases of Barbadoes. 
"I Med. Essays and Observations, p 158, 
f% Beanchi. Histor. hepat. part lii. 

ft M 'Loan's Inquiry into the nature and causes of the great mortality 
mong the troops of St. Domingo. 



214 Proximate Cause of Fever, 

fever of Waicheren, remarked, together with an enlarge- 
ment of the spleen, the diseased state of the liver. " The 
gall bladder," says he, " was distended with dark viscid bile, 
and sometimes ulcerated on its inner surface."* Dr. Parish* 
describing the yellow fever, as it appeared in the hospital 
of Philadelphia, mentions the black appearance of the bile, 
and says that the black vomit in the stomach had a greenish 
cast-t Dr. Mackitrick, in his Inaugural Dissertation, pub- 
lished at Edinburgh in the year 1766, upon the yellow fe- 
ver of the West Indies, informs us that in some patients who 
died of it, he found the liver spacelated, the gall bladder 
full of black bile, and the veins tinged with black fluid blood. 
Dr. Walker, in his account of the pestilential fever which 
prevailed in the island of Jamaica, in the years 1793-94 
and 95, says, "The gall bladder was distended with thick 
b'ack bile, of the consistence of tar, and some of the same 
substance was found in the stomach. J Dr, Dancer informs 
us, that in the yellow fever of Jamaica, he found the liver 
enlarge^ and turgid with bile, and of a pale yellow colour. 
Dr. Stark, in his inaugural dissertation, mentions the 
great redundancy of bile in the epidemic of Philadelphia 
in 1793. "I have seen," says he, "nearly two quarts evac- 
uated in the short space of twenty-four hours. "§ The 
publications of Dr. Physic and Dr. Brown, on the morbid 
phenomena discovered by dissection in the fever of Phila- 
delphia in 1793, among the diseased appearances of the sto- 
mach and intestines, take notice of a black liquor found in 
these cavities, similar to that which had been discharged by 
vomiting and purging before death, of the same appearance 
with that in the gail bladder, and of so acrid a quality as to 
produce considerable inflammation and swelling in the oper- 
etor's hands, which continued some days.|| Dr. Frost, in his 

* Scientific and popular view of the fever of Waicheren, p. 42. 

t Cox's Phil. Med. Mus. Vol. III. 

£ Dr. Clark, speaking of the bilious affections to which the inhabitants of 
the Coromandei coast are subject, observes, that ia the warm months it is 
no uncommon thing to see a patient one hoar vomiting abundance of gall, 
and the next hour taking a ride into the country. But that amongst the 
new settlers, these bilious diseases are more violent and dangerous, and of- 
ten terminate in cholera morbus ; bilious cholic, with spasmodic affections of 
the muscles; and in dysentery. These spasmodic affections, attended with 
vomiting, and described by Dr. Gird'.estone, appear to resemble the tetanic 
emprasthotonus, as described by writers, in affecting principally the mus- 
cles which bend the body forwards. Clark on Long Voyages* p. 80. 

§ Caldwell's Collection of Theses, Vol. II. 

|j Rush's Obvs. and Inq. Vol. III. p. 173. A similar vitiation and redun- 
dancy have been discovered in the small pox. — Chalmers on Ihe Diseases of 
South Carolina, Foil. p. 183. 



Proximate Cause of Fever. 215 

account of the yellow fever of Demarara, among the ap- 
pearances on dissection, notices the following : In some, the 
gall bladder was found empty, and in a few, it contained a 
dark green, ropy bile, but was generally distended with a 
black, thick matter, resembling molasses or tar.* 

That the accumulation of bile in persons residing in warm 
and unhealthy climates and situations, is owing to the state 
of the fluids, and not to the fever, appears from the following 
considerations: 1st. In various instances, this accumulation 
takes place where no fever has existed, and is carried off by 
a vomiting or purging, leaving the person free from all in- 
disposition. 2d. The fever is often protracted and renew- 
ed through winter, but this redundancy of bile, in most 
cases, at that time, no longer exists. 

Some physicians have affected to deny that the yellow 
colour of the skin in the bilious or yellow fever is produced 
by bile ; and have attempted to account for this appearance 
on the supposition of the dissolved state of the blood, by 
which the finer and more attenuated parts of the red glo- 
bules, are effused and lodged beneath the cuticle ; in the 
same way as the skin after the ecchymosis of a bruise, as- 
sumes a yellow tinge. This notion, however, appears to 
be far fetched and erroneous. For, in the first place, this 
yellowness often occurs at an early period of the disease, 
before any dissolution of the blood has taken place; and in 
which, as I have myself seen the crassamentum of the 
blood when drawn, was of a firm consistence, and even 
threw up an inflammatory crust. In no disease is the blood 
more dissolved than in scurvy, yet the skin, different from 
what takes place in bilious or yellow fever, never becomes 
yellow. It is true that petechias, when disappearing, leave 
a yellow tinge where they formerly existed ; but this yel- 
lowness is only in spots, and is circumscribed and very lim- 
ited in its extent : whereas, according to the opinion under 
consideration, instead of purple spots beneath the cuticle, 
the first symptom of this dissolution of the crasis of the 
blood should be a general diffused yellowness over the 
whole surface of the body. 

In my4:reatise on the scurvy, I have pointed out the influ- 
ence of animal food in the production of this disease, and 
attempted to show that its morbific operation consisted in 
changing the fluids of the body from a healthy state, and 
imparting to them an acrimonious and alkaline quality. — 
Such is the nature and economy of the human frame, that 

- SM. Ropos. Vol. XIII p. 253. 



216 Proximate Cause of Fever. 

the process of animalization is in constant danger of pro- 
ceeding too far, and of occasioning a morbid excess, unless 
counteracted by the use of a suitable proportion of vegeta- 
ble nourishment. In a cold climate and in a healthy at- 
mosphere, this tendency and disposition are less remarka- 
ble than in those of an opposite description. In northern 
latitudes the principal morbid operation of the dispropor- 
tionate or undue use of animal food, is the production of 
scurvy, or of a scorbutic habit, with foul breath, spongy 
gums, blotches, ulcerations, and tumors in different parts of 
the body. But in warm and unhealthy ciimates and sea- 
sons, the pernicious effects of the undue indulgence in the 
viands of the table, are more speedily and severely felt. It 
is true that, as in cold and northern latitudes, they have 
sometimes occasioned scorbutic affections of the body, but 
their more usual effect is to produce a predisposition to fe- 
vers and fluxes ; for when their natural tendency and opera- 
tion are aided by an unhealthy atmosphere, loaded with mias- 
matic exhalations, they become doubly injurious to the hu- 
man constitution. 

I have, in a former work, pointed out the analogy be- 
tween fever and scurvy, and have shown that in many in- 
stances they bear a near resemblance to each other. It is 
there also shown that the undue use of animal food has a 
principal share in the production of scorbutic disorders. — 
The same analogy should consequently teach us that the 
use of meats cannot fail to prove prejudicial wherever the 
general causes of fever prevail. For it should be remem- 
bered that the tendency and operation of animal food, and 
the unhealthy miasmata of decomposition on the body, 
though unequal in degree, are still the same : they both 
abound with the principles of alkali ; and it is by this mutu- 
al operation, that the two causes prove so injurious to the 
system : that is, by changing the fluids from a healthy state, 
and rendering them acrid and alkaline. And we are inform- 
ed by Dr. Rush, that during the prevalence of the yellow 
fever in Philadelphia, in 1793, he was subject to profuse 
night sweats, which were so offensive as to oblige him to 
draw the bed clothes close to his neck to defend himself 
from their smell. " They lost their footer entirely," says 
he, "upon my leaving off the use of broth, and living en- 
tirely upon milk and vegetables. **' 

Independent of all reasoning, extensive observation satis- 
factorily proves, that the free and unrestrained use of animal 

* Rush's Ino. and Obs. Vol. III. p. 332. 



Proximate Cause of Fever, 217 

food fn tropical climates, and unhealthy seasons and situa- 
tions, is extremely prejudicial to health, vitiating the fluids, 
producing an accumulation of bile, and proving on many 
occasions, both the predisposing and exciting cause of fever. 
The observations made in my treatise on scurvy upon the 
operation of spirituous liquors as a cause of scorbutic dis- 
orders, are equally applicable to the subject of fever. It 
was there stated that as distilled spirits consist, in a great 
degree, of hydrogen, one of the elementary principles of 
alkali, they must consequently favor that vitiation of the 
blood which disposes to the undue secretion and accumula- 
tion of bile. I have remarked on a former occasion,* that 
there can be no doubt the blood of habitual drunkards 
abounds with a large proportion of hydrogen, as indicated 
by the feeler of the breath. It even appears that hydrogen 
is evolved from the blood of drunkards in a disengaged 
state, and in such a degree of purity as sometimes to take 
lire upon the approach of a lighted candle to their breath. 
The quantity of hydrogen existing in the blood of such per- 
sons, the vitiation of the fluids thereby occasioned, and the 
disposition to the formation of a redundancy of alkali, causes 
an abundant secretion of black and viscid bile ; giving rise to 
violent vomitings and purgings of this offensive, fluid ; which 
commotions are sometimes preceded by headache, deliri- 
um and other symptoms of fever. The operation or effect 
of spirituous liquors upon the blood, is analogous to that of 
animal food and noxious miasmata; they all produce vitia- 
tion of the blood, and give rise to an increased secretion of 
bile. It is as well, by the vitiation of the fluids, induced by 
the habitual use of spirituous liquors, as by the chronic de- 
bility which they occasion, that they affect the legs with 
ulcerations ; in the same way as from the operation of mias- 
mata in tropical climates and unhealthy countries. Jt is 
this sanae condition of the body and vitiated state of the 
blood which produce ulcers, that also give occasion to scor- 
butic affections, to carbuncles and other eruptive disorders, 
incidental to drunkards, which sometimes take place in 
aged persons from the natural processes of the animal acri- 
mony and vitiation of the fluids in advanced life. It is by 
the attenuating effects of spirituous liquors upon the blood, 
rendering it preternaturally thin and fluid, and also by their 
debilitating operation upon the smaller vessels that those dis- 
charges of blood, which sometimes take place from the 
Stomachs and bowels of intemperate drinkers, are to be as- 

* Topography ami Diseases of Louisiana-. 
C % 



218 Proximate Cause of Fever* 

eribed.* Their effects upon the liver and biliary system 
resemble those of noxious miasmata in unhealthy climates. 
Both these causes disorder the function of the liver, and 
give rise to chronic inflammation and enlargement, both of 
this organ and the spleen, which frequently end in fatal 
dropsical affections. The excessive use of spirituous liquors, 
as they abound with the elementary principles of oil, hy- 
drogen and carbon, disposes to the accumulation of fat in 
the celular membrane ; the adipose matter which is formed, 
however, from the undue use of ardent spirits, is not of a 
firm consistence, but of a semi-fluid and oleaginous quality, 
frequently giving to the countenance a swollen and bloated 
appearance. 

Dr. Fordyce, speaking of malignant fevers, remarks, that 
in such fevers the blood is dissolved, and sometimes quite 
ichorous. tb The same sort of blood, 5 ' says he, "is taken 
from those who have thrown themselves into putrid fevers, 
by swallowing large quantities of spirits of hartshorn, or 
who have lived long on putrid food, or who have the true 
scurvy."! 

To produce authority in proof of the dissolution of the 
blood in malignant fever, the writer conceives to be alto- 
gether superfluous ; examples may be found in every author 
who has treated upon the subject of malignant, or as they 
have been called putrid disorders. | These writers repre- 
sent the blood as being mixed with all the excretions of the 
body, and on various occasions flowing from the nose, gums, 
corners of the eyes, bladder, intestines, stomach, and, ac- 
cording to Lind, a bloody serosity exuding from the fore- 
head and armpits. It is the same dissolution of the blood 
that gives rise to purple 5 spots and blotches on the surface 
of the body, called petechias, macula and vibices, from the 
effusion of blood beneath the cuticle. 



* Two cases, the one of a man, and the other a woman, are mentioned 
by Dr. Darwin, who, having impaired their constitutions by the intemper- 
ate use of spirituous liquors, were seized with a ceasely haemorrhagy from 
their mouths, and from every part of the skin where they happened to 
scratch themselves, which continued some days till they died. 

t Fordyce on Putrid and Inflammatory Fever, p. 60. 

^ For illustrations on this point, the reader is referred to'Huxham on Fe- 
ver ; Shebbeare's Practice of Physic, p. 169; Lind on Seamen, p. 52; 
Schwenke, H aematolog. p 90; Cleghorn, Dis. ot Minorca, p. 95 ; Fordyce 
on Put. Inflam Fev. p. 60 ; Walker on Small Pox, p. 109; Hunter on the 
Dis- of Jamaica, p. 171 ; Mitchell on the Yellow Fever of Virginia, in 1741 ; 
Rush on the Yellow Fever of Philadelphia, iu 1793 ; Med. Inq. and Obs. 
Vol. III. p. 159, &c. 



Proximate Cause of Fever: 219 

It may not be improper to notice in this place, the erro- 
neous and gratuitous assumption of Dr. Rush, upon the sub- 
ject of the dissolution of the blood in malignant fevers. The 
Doctor remarks, that this dissolved state is a sign of the 
highest excitement and activity in the sanguiferous system, 
and that it is owing to the immoderate action of the blood- 
vessels upon their contents, which u tears and rends it (the 
blood) to pieces. 5 ' Such a theory was convenient for the 
Doctor, in order to establish the necessity and importance 
of blood letting in such cases; which in bis zeal for gener- 
alization and unity of diseases, he labored to inculcate the 
sine qua non of medical prescription. But, though in this 
instance, Dr. Rush, like the immortal Columbus, has the 
merit, as* he had the boldness, of launching forth into a 
trackless ocean, where, hitherto the glance of imagination 
had never wandered ; yet, unlike that matchless seaman, he 
wanted chart, compass and probability, to sanction his en- 
terprize, and direct his progress, and finally to conduct him 
to the achievement of successful and important discoveries. 
We will just remark, that were the opinion of Dr. Rush 
correct on this subject, we should always find the greatest 
dissolution of the blood where there existed the most vio- 
lent excitement of the heart and arteries, as in pleurisy and 
other inflammatory diseases ; whereas, the reverse of this is 
always the case, and is rendered sufficiently striking by 
comparing the blood drawn in inflammatory diseases with 
that of many malignant fevers. 

It would appear from the consideration of what has alrea* 
dy been advanced, that by the operation of the remote 
causes of fever, a change in the condition of the fluids of the 
body is effected, and that to this change from a healthy to 
a morbid state, the various symptoms and phenomena of 
fever are to be ascribed. 1 am at the same time, however, 
fully aware that there are many symptoms of fever that 
cannot be explained without a reference to the brain and 
nerves ; such as pains, spasms, delirium and convulsions : 
but it is well known that these symptoms may all be pro- 
duced by a primary operation on the sanguiferous system* 
We can hardly suppose that an organ of such a delicate 
structure as the brain, should not feel the effects of any vi- 
tiated fluid circulating with increased violence through its 
substance, rapidly depriving it of its accustomed nourish- 
ment and health, and depositing poison instead of a healthy 
secretion. And we accordingly find that all extraneous and 
poisonous substances, when injected into, or taken up by 
the blood-vessels, produce similar effects. Thus the retea- 



230 Proximate Came of Fever, 

tlon of excrementitious matters in cases of ischuria, has 
produced every symptom of the most malignant (ever, and 
after death, urine has been found extravasated into the ven- 
tricles of the brain.* M. Delile and M. Magendi of Paris, 
have demonstrated the power which poisons possess in af- 
fecting the nervous system, when admitted into the blood- 
vessels ; and have shown that their operation can only be ex- 
plained upon the principle of their being received into the 
general circulation, and through this medium acting upon 
the nervous system. This was "illustrated by the following 
experiments: The thigh of a dog was amputated with the 
exception of the trunks of the crural vein and artery ; the 
thigh was then pierced with a pointed piece of wood dipped 
in the upas ; in another, a few drops of the upas were en- 
closed between ligatures, in a section of the intestines divid- 
ed from the mesentery, and having no other connexion with 
it, than by a vein and artery. In both cases the poison was 
carried from the insolated parts into the general circulation 
by the vessels which remained, and the animals died of te- 
tanus, in the same way, though the effect was not so sudden, 
as when the poison was applied to the spinal marrow cut 
transversely. t Experiments to the same purpose have been 
made by Dr. Wilson Philip and others. 

The coma, stupor, and oppression in fever, may be as- 
cribed partly to the direct influence of the morbid condition 
of the blood itself upon the brain, and partly to its dissolve 
ed state, by which serum is effused into the ventricles, pro- 
ducing the symptoms of compression. 

Even from the imperfect knowledge which we possess of 
the animal economy, we have every reason for concluding 
that the immediate cause of fever exists in the circulating 
fluids. We know from extensive experience that the nerv- 
ous system may be violently affected without disordering 
the functions of the heart and arteries : and independent of 
experience in disorders, we are led to the same conclusion 
by physiological knowledge, from which it appears that the 
heart and arteries are not influenced by causes acting on 
that portion of the nervous system connected with the vol- 
untary functions. These sympathies, however, are not re- 
ciprocal ; for universal experience teaches us that in all dis- 
eases of the sanguifeious system, the brain and nerves are 
more or less affected. We see this in the inoculated small 

* Fevier. Med. Hist, and Reflect. 

t See the Amer. Med. and Philos. Reg;. Vol. I. p. 17 1 & 426. These ex- 
periments were made with a view of ascertaining whether there is any 
direct absorption by the veins, which they render probable. 






Proximate Cause of Fever. 221 

pox, in that form of fever produced by the retention of 
urine, in cases where poison has been injected into the 
blood-vessels, and in fevers generally. 

How far physicians have been from arriving at a know- 
ledge of the proximate cause of fever, satisfactorily appears 
by recurring to the theories of Boerhaave, Hoffman, Cullen, 
Brown, Darwin, and others. It would be an useless expen- 
diture of time, to examine minutely, all the hypotheses of 
these respective authors : hypotheses of which the improved 
state of medical science-has since demonstrated the errors 
and absurdities. 1 shall, therefore, just glance at a few of 
the leading features of their systems. 

Since the doctrine of Boerhaave of lentor and error loci 
of the blood became unfashionable, physicians have almost 
entirely diverted their attention from the consideration of 
the fluids, and have searched for the hidden nature of fever 
among the soft solids of the body. Since the revival of the 
antiquated doctrine of Hoffman by Cullen, and the innova- 
tions of Brown and Darwin, the pretended laws of excita- 
bility and irritability, have governed the minds and directed 
the writings of succeeding physicians. 

The doctrine of excitability, as laying the foundation of 
the proximate cause of fever, has been elaborately discussed 
by Dr. Wilson Philip, in his work on febrile diseases; but, 
the degree of confidence and credit which Dr. Philip him- 
self attached to it, may be gathered from the contradiction 
which he himself gives to it in the Appendix of the above 
mentioned work. After all his iaborious devotion to the 
theory of Brown, and the great pains he has taken to rectify 
his errors, he there openly renounces his former hypothesis, 
and shows himself an avowed advocate of the humoral pa- 
thology. Such an avowal, however, is highly creditable to 
Dr. Wilson Philip, for how few do we find, who, upon con- 
viction, are willing to acknowledge the former errors which 
misled them, and which they showed a zeal in supporting? 
What is to be regretted, however, in the work of Dr. Philip, 
is that he has taken so much unprofitable pains to support a 
theory so unsubstantial and erroneous. It is quite immate- 
rial under what new aspect and variety of forms this doc- 
trine is pursued ; whether of a change in the laws of exci- 
tability, or any other derangement of the principle of nerv- 
ous energy and excitement, they are all equally inconclusive 
and unsatisfactory. Is not the nature of fever quite as well 
understood by the doctrine of atony and spasm, according to 
Dr. Cullen, as by the laws of excitability of Brown, by the 
change in the laws of excitability, or any other change in 



222 Proximate Cause of Fever* 

the distribution of the nervous fluid, or the concealed and 
undiscovered agency of the brain and nerves? Even ad- 
mitting this change of excitement, excitability, and other 
nervous derangements in the existence of fever, it is evident 
that these changes are produced by some more immediate 
and essential cause acting on the system 5 and, therefore, 
cannot be considered as the proximate cause of disease itself. 

From what has been previously remarked, I think it will 
fee admitted, that the noxious miasmata, producing fever, are 
received into the mass of circulating fluids, and there pro- 
duce the various phenomena of fever. If, with Dr. Cullen, 
we refer the febrile commotion of the heart and arteries to 
atony and spasm, and to the vis medicairix naturee, we in- 
volve ourselves in a mist of obscurity and darkness. 

It has been already remarked that the noxious miasmata,, 
which give origin to endemic fever, by changing the heal- 
thy condition of the blood, and by rendering it preternat- 
uraily acrid and alkaline, give occasion to the generation of 
an increased quantity, and to a redundancy of vitiated and 
unhealthy bile. Now, one method which nature takes, un- 
der these circumstances, to effect a cure, is by exciting a 
yomiting or purging, or bath, of the offending matter; and 
not unfrequently, a cure is accomplished at the commence- 
ment of the disorder by these means. We are hence led 
to conclude that this abundant secretion of bile is a neces- 
sary process of the animal economy to free itself from mor- 
bific matter generated in the circulating fluids; and which, 
if not speedi'-y evacuated in this manner, becomes the 
cause of serious derangement. It was from observing this 
excessive redundancy of bile in the summer and autumnal 
fevers of warm climates, that several physicians have been 
led to consider the bile as the proximate cause of fever. 
The reader will perceive, however, that this was taking but 
a partial and imperfect view of the subject : for this re- 
dundancy of bile implies some deviation from the healthy 
state of the system, as the immediate cause of this inordi- 
nate and morbid secretion.. Besides, it would be contrary 
to all known laws of the animal economy to suppose that 
nature should so deviate from her course as to occasion 
this accumulation of bile for no other purpose than to prove 
the occasion of disease, or to constitute the proximate cause 
of fever. If alarming consequences sometimes arise from 
the vomiting and purging cf bile, as in the cholera morbus, 
this onlj shows that nature, when excited into action for 
her own health and preservation, may sometimes proceed 
to dangerous excess. Moreover, she merely adopts, in : 



Proximate Cause of Fever, 223 

such cases, the very same means that would have been em- 
ployed by art, to effect the expulsion of the morbid cause* 
An accumulation of water in the thorax or abdomen not 
unfrequently proves fatal, yet no physician would show such 
an ignorauce of pathology as to consider this accumulation 
as the proximate cause of dropsy ; mistaking a symptom 
for the disease itself. The analogy is strictly applicable to 
the subject under discussion ; and as well might it be con- 
tended that an immoderate secretion and flow of urine is 
the proximate cause of diabetes, as that an inordinate se- 
cretion of bile is the proximate cause of bilious fever* 

Much of the morbific matter circulating in the fluids is 
undoubtedly eliminated from the general circulation by the 
biliary organs, and discharged by the way of the stomach 
and bowels. It is the business and function of the liver to 
free the system from excess of gross, alkaline and acrimo- 
nious matters, and as there is a particular determination of 
such morbid matters to the liver, it is very possible that, at 
the commencement of indisposition, the materials of fever 
may be so far evacuated, by the exhibition of an emetic or 
cathartic, or both, as to put a stop to the progress of the dis- 
order, and kill the disease in the very germ of its origin* 
This effect I have frequently observed from the employ- 
ment of the remedies above mentioned ; and all persons 
conversant with fevers have probably made the same ob- 
servation. In my treatise on scurvy, I have illustrated the 
affinity of that disease to idiopathic fever by the following 
facts. 

" Both scurvy and fever often arise under similar circum- 
stances of weather, climate, situation, &c. ; as in low, damp, 
marshy places, rainy seasons, bad air, and from miasmatic 
exhalations. 

" Afebrile state is also sometimes attendant upon scurvy. 
Dr. Lind informs us, that some of his patients had a fever- 
ish pulse, and complained of head-ache and thirst ; and that 
a tertian or quartan ague, with perfect intermissions, some- 
times accompanies this disease* I have also noticed the 
same occurrence. Dr. William Brown, in a letter to Dr. 
Guthrie, of St. Petersburgh, giving an account of the scurvy 
which prevailed in Russia, in the year 1787, states, that the 
force of the heart and arteries seemed, in many cases, to 
be increased, if we may judge from the state of the pulse, 
which, frequently, on the patient's first arriving at the hos- 
pital, was full and hard. Even in some cases, when, during 

* Lind on Scurvy, p. 50$. 



224 Proximate Cause of Fevet: 

the whole course of the disease, the pulse had heen in a 
natural state, inmost respects; yet, a few days before death 
it attained a wonderful degree of force. An increased de- 
gree of heat was also observed.* 

" Dr. Lind says, that in the course of the year 1 746, seve- 
ral of his scorbutic patients were feverish in the beginning 
of the distemper.! In Lord Anson's voyage, it is related 
that this malady was accompanied with other dangerous 
symptoms, besides those strictly scorbutic, particularly pu- 
trid fevers, pleurisies, jaundice, &c. Bursenus distin- 
guishes a fever which he calls scorbutic tertian, on account: 
of the symptoms of scurvy manifested by it.f Ettmuller 
also makes mention of a scorbutic tertian, and has been 
followed by Sauvages. That mentioned by Ettmuller could 
be cured by antiscorbutics only, or chiefly ; seldom yield- 
ing to bark.§ Morand likewise takes notice of a similar 
disease ; with this difference, however, that it was immedi- 
ately stopped by the bark. Dr. Alibert observes, that, in 
the climate of Middlebourg, the malignant intermittent is 
oftentimes united with the scurvy; and that this complica- 
tion is known from the foetor, the flaccidity, and the erosion 
of the gums, the deep color of the urine, the blotches on 
the skin, &c. In the treatment of it, the bark is advan- 
tageously joined with acids. || Sinopeus acquaints us with 
a similar coincidence: "Although the scurvy," says he, 
"was a distemper bad enough of itself, it was, however, 
often rendered worse by being complicated with other in- 
tercurrent diseases, viz. fevers and rheumatism, but espe- 
cially the intermitting fever."TT Dr. Lind, speaking of the 
scurvy in Hampshire, says, such as died of fevers had their 
legs, several days before death, covered with scorbutic small 
spots, of a purple, red, or black colour.** The same au- 
thor observes, in another place, that a fever appeared on 
board the Edgar, in a few months acquiring great vigor, 
which, together with a supervening scurvy, destroyed sixty 
of her crew. ff Bisset, in a treatise on scurvy, states, that 
the bilious fever of the West Indies often attacks such as 
are highly predisposed to scurvy, as also those who are re- 

* Dune. Med. Comment. Vol. XIL p. 342. 

+ Lind on Scurvy, p. 107. 

J Bnrser. Instit. of the Prac. of Medicine, Vol. I. p. 344, 

j Ettmul. Opr. torn. ii. p. 324, & seq. Colleg. Practic. sec. xv. cap. 2. 

jj Alibert on Malig. Intermit, p. 257. 

ff Parerga iWedica Conscripta, quoted by Lind, p. 405. 

** Lind on Scurvy, p. 274. 

it Lind on Fever and Infection, p. £,. 



Proximate Cause of Fever, 225 

covering from it ; in both cases proving very fatal. And 
Rouppe mentions a man who died of yellow fever and scur- 
vy, in the island of Curracoa. Dr. BSane observes, that in 
the ship Alcides, while on a cruise in rainy weather, which 
increased the number of sick, those men chiefly were at- 
tacked with ^evev, who were ill of ihe scurvy.* 

" Haemorrhages from the gums and other parts of the body 
are common in the more aggravated stages of scurvy; so 
are they also in the more malignant forms of fever. 

; ' Dr. Thomas Clark, on the subject of the yellow fever, 
remarks, that in violent cases, the gums, towards the end of 
the second day aie often sensibly swelled, and of a deep red 
colour, resembling what takes place in scurvy, and soon 
after blood is effused from them in very considerable quan- 
tity."! 

Such is the analogy between scurvy and fever; and on a 
previous occasion, I conceive, I have satisfactorily proved, 
that the proximate cause of the former consists in a redun- 
dancy of alkali in the mass of circulating fluids. In fever* 
this condition is less striking ; yet judging from analogy and 
other circumstances of fever itself, I am induced to believe 
that in the latter a similar condition of the animal fluids also 
exists. 

The various experiments made by Smith, Morveau and 
others, have, I conceive, established the eflicacy of acid 
gases in destroying infection or the matter of fever. To 
these considerations in favor of the alkaline quality of the 
fluids in fever, may be added the great utility of the acids 
in its treatment, and the importance of fruits of an acid 
quality in their prevention, as also, the fact mentioned by 
Dr. Mauduit, that the matter which flowed from the buboes 
of patients laboring under the plague, changed vegetable 
blue colours like ammonia. J We are also informed by Dr. 
Arthaud, that upon dissection of a person who had died of 
yellow fever, the urine changed the tincture of radishes to 
a green color ;§ thus unequivocally demonstrating the pres- 
ence of alkali in an uncombined state. 

As diseases arising from the same causes assume different 
symptoms, yet partake of the same nature, and require sim- 
ilar indications of cure, it is evident that any division and 
arrangement, founded on the mere analogy or diversity of 

* Blane on the Dis. of Seamen, p. 57. 
+ On the Nature and Cure of Fever, p. 201. 

$ Experiments instituted to determine the Nature of Pestilential Virus, 
Sec. Journal de Physique, p. 120. 
5 Rosier'? Journal for January, 1790, Vol. XXX. p. 380. 



$£& Proximate Cause of Fever. 

symptoms, cannot contribute either to the knowledge of 
their nature, or to the improvement of their treatment. — - 
Gregory, Home, Whytt, Huxham, Fordjce. Brocklesby and 
others, recommend and adopt the division of diseases ac- 
cording to the causes and method of treatment : an arrange- 
ment unquestionably the most natural and unexceptionable. 
Perhaps it may be objected that, admitting the causes of 
fever to act immediately upon the heart and arteries, why 
is it observed that the nervous system appears generally to 
be primarily affected 1 To this it may be answered, that it 
is only from affections of the brain and nerves, occasioned 
by the disordered condition of the vascular system, that we 
are made sensible of any derangement in the phenomena 
of health. The action of the heart and arteries may be 
highly excited by exercise without inconvenience or de- 
rangement to the functions of health: but let any of the 
customary secretions be only for a short time suspended, 
and the consequences immediately show themselves in mor- 
bid affections of the whole animal economy. In the latter 
case, the retention of excrementitious matters renders the 
blood preternaturally stimulating, and consequently excites 
the heart and arteries to greater frequency and strength of 
action. In the case of exercise, the blood being propelled to 
the heart in greater quantity, and with more rapidity, from 
the contraction of the muscles, produces a temporary ex- 
citement, as in the cases of suppressed perspiration, which 
abates with the cessation of the exercise that gave rise to it. 
Now supposing that a preternatural portion of irritability, 
or in the Brunonean phraseology, of excitability, is trans- 
ferred to the blood vessels, this state of being more easily 
excited by the same agent, the circulating fluids, will be 
equivalent to an increase in the quantity or acrimony of the 
blood itself: but as there can be no proof of such a trans- 
fer of excitability from any known operations of the animal 
economy, we of course are bound to reject the supposition, 
as unfounded, and to consider the efficient cause of fever as 
existing in the circulating fluids. The quality of excitabil- 
ity is to be excited ; but it often happens in malignant fever, 
in different patients laboring under the same epidemic, that 
the action of the heart and arteries in one is below the nat* 
ural and healthy standard ; and in another, the vascular ac- 
tion is highly excited : according to the doctrine of excita- 
bility here would be a difference in the proximate cause of 
the same disease: for if it be contended that the excess of 
excitability has been destroyed by the violence of the stim- 
uli applied, I would ask, according to the Brunonean doc- 



Proximate Cause of Fever. 227 

trine, what stimuli ? The natural stimuli of the body are 
various objects that act upon the senses and sensorium 
commune, food, drink, and exercise; but when none of 
these causes have been suffered to act upon the body to any 
injurious extent, or when they have been applied to two pa- 
tients equally, how shall we account for the violent arterial 
action in the one patient, and for the languor and debility in 
the other? But it should be considered by the advocates of 
the Cullenian and Brunonean systems, that there are other 
important stimuli of the body which, in the investigation of 
the phenomena of diseases they have almost entirely over- 
looked and neglected ; these are the various contents of the 
vascular system, and of the different organs and viscera of 
the body. Thus the food is the natural stimulus of the 
stomach and intestines, the urine of the ureters and bladder, 
the blood of the heart and blood vessels, &c. By referring 
the phenomena of fever to the morbid condition of the fluids, 
the difficulties and beggings of postulata are removed : for 
according to this doctrine it will be readily understood that 
in one case the stimulating quality and acrimony of the blood 
may be such as to excite the sanguiferous system into vio- 
lent action, and in another this morbid power may be so 
great as to destroy or overpower the vigor, tone and strength 
of resistance in the arterial fibre : this is often observed in 
cases of animal, mineral and vegetable poisons; from the 
presence and operation of which, the pulse is rendered slow 
and languid, in the same manner as takes place in malignant 
and pestilential fevers. Though we know not by what se- 
cret peculiarity and agency it is, that the vessels of each 
gland and function of the body separate the particular fluids 
which their various purposes assign them; though from any 
thing which the eye of the nicest, most expert and delicate 
anatomist can discover, the structure of the kidneys is as 
well adapted to the secretion of the pancreatic fluid as that 
of the pancreas itself; yet we know that such a peculiarity 
of glandular structure and appetency exists. But their vari- 
ous adaptation of the different glands and organs of the body 
to the performance of their particular functions, it would ap* 
pear, exists only in relation to their natural stimuli and con- 
tents. Let any unnatural or unaccustomed stimulus be ap- 
plied to them, and they are thrown into preternatural and 
disordered action. Thus a small quantity of spirituous li- 
quor will produce intoxication or high excitement in a per- 
son unaccustomed to its use, whereas on an habitual dram 
drinker it would have little effect: thus, too, the blood in 
its purest state of assimilation is the natural stimulus of the 



228 Proximate Canst of Fever. 

sanguiferous system, but let any other, even the blandest 
fluid, be injected into the blood vessels, even in minute 
quantity, and death or violent derangement is the conse- 
quence : the urine is the natural stimulus of the urinary or- 
gans; but should a minute portion of gonorrhoea! virus, 
though possessing less sensible activity than the urine, come 
in contact with the urethra, violent inflammation would 
speedily ensue. So with respect to the heart and arteries, 
the miasms of fever act as an extraneous and unnatural stim- 
ulus, which none of the various glands and organs of the 
body have hitherto been accustomed to separate and secern 
from the general mass of circulating fluids. 

From observing the symptoms which take place in inter- 
mitting fever, we know that the brain and nerves are mate- 
rially affected at the commencement of the paroxysm. But 
it has been shown that various substances injected into the 
blood vessels, also affect the nervous system. Such nervous 
symptoms, therefore, can afford no argument that the essen- 
tial and immediate cause of (ever does not exist m the blood 
vessels, and through them communicating its effects to the 
brain and nerves. In intermitting fever, the morbific mat- 
ter is in one of the mildest states capable of producing dis- 
ease in the general system; but between this and the most 
aggravated and deleterious properties of the materies morbi 
there are various gradations and degrees. In some cases, 
the operation of the febrile cause is so sudden and violent as 
to produce immediate death. Instances of this nature have 
been previously noticed. The immediate effect of the op- 
eration of infection, when the cause is strong, is nausea, or 
a disagreeable sensation at the stomach, an unpleasant taste 
in the mouth, vertigo, or giddiness, more or less shivering, 
and sometimes a sense of suffocation. When the operation 
is more violent, the person is seized with delirium, or raving 
madness, or becomes stupid or apoplectic, and falls upon 
the ground. This sudden affection appears to depend upon 
the immediate operation of the infection upon the nervous 
system ; and a longer or shorter time is afterwards required 
for the production of fever. 

The cold, or chilly ht of fever seems to be occasioned by 
an unnatural impression on the nervous system, from the ir- 
ritation of the morbific matters, in much the same way as 
irritation from other causes sometimes produces the same 
effect. Thus, the irritation of a stone in the bladder, the 
introduction of a catheter, strangulated herina, the pain of 
hemorrhoidal affections, calculi in the gall bladder, the in- 
troduction of a strong enema into the rectum and the for- 



Proximate Cause of Fever. '229 

mation of an abscess, have all been the occasion of rigors, 
resembling the cold or shuddering stage of fever. From a 
general affection of the nervous system, there is at the com- 
mencement of a paroxysm of fever and ague, and often, also, 
in the bilious remitting or yellow fever, a honipilatio, and 
a shrinking and coldness of the extremities and of the sur- 
face of the body, the smaller vessels are constricted and 
rendered impervious, and the weight of the circulating fluids 
is thrown upon the heart and larger vessels. This accumu- 
lation of blood in the central arteries naturally excites them 
into increased and preternatural action, which is still fur- 
ther increased by the vitiated and irritating condition of the 
circulating fluids. This increased action of the heart and 
larger arteries at length overcomes the debility, inaction 
and torpor of the smaller vessels, upon which a general per- 
spiration taking place, the laboring vessels are relieved from 
the irritating matter which stimulated them into preternat- 
ural action. In this manner an intermission is effected ; for 
when the morbid matter is so far evacuated that the remain- 
der is no longer capable of supporting a febrile action, the 
symptoms of fever disappear. But as part of the morbid 
matter is still left lurking in the vessels, from the power 
which it possesses of assimilating a portion of the fluids to 
its own nature, the febrile symptoms, at times, again recur, 
and go through their various stages as before. Now to pre- 
vent this recurrence, one of two things is necessary, either 
the total expulsion of the morbific matter, or else a state of 
insensibility to its action, produced by such remedies as in- 
crease the tone and vigor of the system, or diminish its irri- 
tability, as the exhibition of narcotics. When the healthy 
functions of the animal economy are by these means resto- 
red, the materials of disease are eliminated by the natural 
excretions. On many occasions, the morbid poison is so 
virulent, that after producing symptoms of high excitement 
for a short time, instead of effecting its own expulsion, either 
in whole or in part, as in intermittent fever, and establish- 
ing convalescence, it occasions prostration and collapse ; in 
which the febrile symptoms, beat and high arterial action, 
indeed, subside; but they subside because the power of the 
heart and arteries is exhausted, and can no longer be exci- 
ted into vigorous action. 

In most other fevers, besides the intermitting, the affec- 
tion of the nervous system at the commencement of the dis- 
order is much less regular and certain ; and although in 
many instances of the bilious remitting fevers of warm and 
tropical climates, some degree of chilliness is perceived to 



23CK Proximate €ause of Fever, 

usher in the paroxysms, yet in manpothers, and those of the 
most malignant character, no sensation of this kind is mani- 
fest either to the patient himself or to his nurses and at- 
tendants : so that the sensation of chilliness, the rigors, and 
the shrinking of the surface, form not an essential or neces- 
sary part in the phenomena of fever. In many and the 
worst cases of fever, the order of an intermittent paroxysm 
is not observed ; simple excitement of the blood vessels, 
with little or no nervous affection, takes place, and the va- 
rious nervous symptoms which subsequently ensue, as coma, 
delirium, convulsions, &c. all refer themselves to the mor- 
bid condition of the circulating: fluids. Dr, Cullen consid- 
ered the paroxysm of an intermittent the natural, regular, 
and more perfect order of idiopathic fever; and endeavored 
to account for the successive stages on the supposition of 
sedative powers, atony and spasm, and the vis medicatrix na- 
tural. But as the coldness and shrinking of the surface of 
the body, only mark the milder grade of the disease, there, 
consequently, is no necessary connexion between this and 
the other symptoms of fever; and one link, in the Doctor's 
chain of causation, being broken, leaves it, as it is, unsup- 
ported and imperfect. 

The symptoms of fever will, at different times, be vari- 
ously modified, by the different state of the moving powers, 
and of the muscular and irritable fibre : but it should at the 
same time be recollected that the health, soundness, and 
freedom of action in the animal machine, depend primarily 
upon the purity of the circulating fluids. If these are cor- 
rupted, the whole economy soon becomes disordered ; but 
should the morbid poison introduced be too powerful for 
the strength and tone of the vascular system, the powers of 
life become suddenly prostrated, and the system sinks with- 
out the possibility of reaction. If the poison is strong, this 
stage of increased action will be of short continuance, and 
that of typhus, or of prostration and collapse, will speedily 
ensue : should the febrile matter be less powerful, the symp- 
toms of vascular excitement will be more fully developed 
and longer protracted. When the cause is still less viru- 
lent, the inflammatory symptoms will be variously protract- 
ed, according to the constitution of the patient and the state 
of the muscular fibre. 

A further explanation of this subject will be found under 
the head of the Operation of the Remedies employed in In-, 
termitling Fever*, as also those oi [Prevention and Cure: 



Of the Symptoms of Fever* 231 

CHAPTER IX. 
OF THE SYMPTOMS OF FEYER. 



The symptoms as here detailed, though suited in a con- 
siderable degree to the endemic fever of the southern states 
in general, are more especially characteristic of the fevers 
of Louisiana and Florida : the fevers of Alabama will be 
more distinctly treated of hereafter. 

The attack of this disease is somewhat diversified, ac* 
cording to season, constitution, <&rc. ; being sometimes more 
sudden, at others more slow and gradual in its invasion. — * 
When the exciting cause has been strong and long contin- 
ued, the disease comes on suddenly and proceeds rapidly to 
the height of febrile exacerbation. Generally, however, 
the patient is admonished of the threatened attack by vari- 
ous premonitory symptoms fluctuating between health and 
disease. For the first twelve or twenty-four hours, he is 
affected with listlessness, want of energy and disinclination 
to motion ; and exertion of every kind becomes laborious 
and irksome. There is frequently a disagreeable or bitter 
taste in the mouth, a want of appetite, a degree of nausea, 
though the patient often flatters himself that there is nothing 
serious in his indisposition. Upon sitting down to his cus- 
tomary meals, he feels more sensibly his deviation from 
health ; at such times the sight and smell of animal food be- 
come unpleasant and disgusting; and he rises from the ta- 
ble with an aggravation of the symptoms. The sensation 
of languor and lassitude increases to a degree of anxiety 
and uneasiness ; perception is impaired, the mind is fatigued 
with the slightest attention, and exercise is difficult and 
painful. An uneasy sense of stiffness is perceived in the 
motion of the eyes, a degree of tension is felt across the or- 
bit, and a dull, heavy pain in the head. The joints feel stiff 
and fatigued, as if the person had just performed a weari- 
some march; an uneasy sensation takes place in the small 
of the back, and a soreness affects the muscles of the legs ; 
the animal functions are debilitated, and great anxiety at 
times pervades the system. The countenance, when ex- 
amined at this early period of the disease, exhibits a devia- 



^32 Of the Symptoms of Fever, 

tion from health, the features are dejecting and desponding, 
the complexion sallow, the eyes dull and heavy. For a 
short time the patient seems to stand tottering upon the 
isthmus between health and disease, flattering himself that 
his indisposition is slight, and that in the course of a day or 
two, health will return without the interference of medical 
aid. At times, he thinks his disorder imaginary, and endea- 
vors to partake in the passing amusements ; he, however, 
soon finds himself fatigued, and so much indisposed as to be 
under the necessity of going to bed. If he is a person ad- 
dicted to the use of spirituous liquors, he endeavors to dis- 
pel his languor by having recourse to his accustomed stim- 
ulus, which is but adding fuel to the dormant spark. In 
the meantime, the disease has only been slumbering; the 
insidious enemy gathers strength by delay, and at length 
makes a sudden and violent attack upon the vital functions. 
The disease is not unfrequently more sudden in its attack, 
and more rapid in its progress. In both, the febrile affec- 
tion is often, though by no means always, ushered in with 
more or less chill, or slight sensation of chilliness and di- 
minution of the natural temperature, slight flushes of heat, 
alternating with transient, or more protracted chills and 
unequal distribution of the vital action — pain in the back, 
limbs and head — small, frequent, contracted, sometimes 
irregular pulse — anxiety — nausea — sighing and impeded 
respiration. The nausea and sieknes increases, and vomit- 
ing often ensues ; the contents of the stomach are at first 
thrown up ; and generally a quantity of yellow or dark col- 
oured bile, by the subsequent efforts of vomiting : some- 
times a distressing retching takes place after the bile is tho- 
roughly evacuated, by which nothing but a viscid mucus is 
discharged. Notwithstanding the stomach is entirely empty, 
the straining and efforts to vomit are almost incessant ; and 
such is the irritability of this organ, that medicines and sub- 
stances taken for its relief, frequently increase the disorder. 
It sometimes happens that this vomiting continues with una- 
bated violence till the final extinction of life : the patient is 
harassed, and at length, exhausted by the violence of the 
straining, becomes insensible, and lies in a state of comatose 
stupor; he is affected with difficult stertorous breathing, 
gasps for breath, and mutters indistinctly ; the extremities 
and surface of the body become cold ; the pulse frequent, 
weak and trembling; a cold slimy sweat stands in drops 
upon his forehead, and bedews the surface of-the body ; the 
low delirium continues ; the vomiting of discoloured green- 
ish, olive, or brownish matter ceases ; the pulse becomes 



Of the Symptoms of Fever. 238 

feeble, frequent and scarcely perceptible, faulters and in- 
termits, and an expiring gasp closes the scene : and thus the 
patient is sometimes carried off at an early stage of the dis- 
order. Should not this excessive vomiting and the state of 
depression connected with it terminate fatally, an alarming 
degree of coldness is apt to ensue, from which the patient 
is with difficulty recovered. 

When the attack is less severe, as is more frequently the 
case, the pain in the back and limbs diminishes, and is suc- 
ceeded by a violent pain in the head, with a sense of ten- 
sion, fullness and throbbing over the eyebrows, and in the 
temples. The circulation is accelerated; the heart and 
arteries beat violently ; the pulse is frequent, strong and 
bounding, or hard, wiery and contracted ; the surface of 
the body is red, inflamed, sometimes sore to the touch, and 
is dry, hot and parched ; the respiration is short, frequent, 
anxious and laborious ; the patient gasps for breath, appear- 
ing evidently in danger, and in the act of suffocation. The 
tongue, mouth and fauces are robbed of their natural mois- 
ture, and partake of the general dryness and aridity of the 
surface. The thirst is great and insatiable, but the stomach 
is easily oppressed with liquids, and frequently rejects the 
drink that has been swallowed, hi more favorable cases, 
this hot stage, after continuing for a longer or shorter time, 
is succeeded by the sweating stage, during which the sweat 
flows freely from every part of the body; and is succeeded 
in the morning by an abatement of the violence, and are- 
mission of all the symptoms. In other cases, the fever con- 
tinues with little abatement of its severity; a slight perspi- 
ration is, perhaps, perceived about the forehead, and on the 
superior parts of the body ; or the perspiration, though 
considerable, has not been effectual in procuring a corres- 
ponding remission of the symptoms. 

In the progress of the disease, deafness sometime super- 
venes, and the colour of the tongue, from being white, as- 
sumes the successive shades of yellow, olive, purple, and 
finally becomes perfectly black. 

Where there has been no evident crisis, or perspiration, 
but the symptoms of excitement have continued with little 
or ho abatement or remission, the febrile action subsides af- 
ter a longer or shorter time ; the skin remaining dry, but be- 
coming shrunk, constricted and cool; the tongue is moist, 
and either clean, or covered with a brown or sooty fur; the 
pulse from being full and strong, or hard and resisting, be- 
comes soft, frequent, and sometimes irregular; scurfy and 
angry, or dark and livid eruptions make their appearance 



234 Of the Symptoms of Fever. 

about the angles of the mouth ; a yellowness sometimes ap- 
pears upon the surface of the body ; the adnata of the eyes 
assumes a jaundice tinge, and a cadaverous sallowness or 
olive hue overspreads the countenance 5 the eyes are inani- 
mate, watery, and red ; the features dejected, the nose 
sharpened, the patient deranged or comatose* This state 
marks the period of collapse. The situation of the patient 
is not yet hopeless; but the remaining stregih requires to 
be economized with the greatest care : though the pulse may 
possess a considerable degree of strength and fulness, the 
extraction of a few ounces of blood, or the exhibition of an 
active cathartic might prove speedily fatal, Mild aperi- 
ents, as cream of tartar, mindererus spirit, the effervescing 
draught, composed of the carbonate of soda and lime juice, 
injections, and the occasional exhibition of a little wine, 
gruel or arrow root, are all that are admissible. When the 
case terminates favorably, the patient, in a few days, gradu- 
ally emerges from this state of prostration ; the pulse again 
acquires strength and steadiness ; the fever rises and falls 
several times, perhaps, in the course of the twenty-four 
hours, and stimulants are no longer necessary or proper, 
except during the remission, or when the fever comes to a 
distinct intermission, when a little wine may be given wi(h 
the bark either in substance or decoction, according as the 
stomach can bear it. When the disease terminates fatally, 
in many cases, the yellowness increases, and every part of 
the body at length exhibits a deep saffron dye^ sometimes 
interspersed with livid or purple petechias, and extensive 
eccbymoses, in the form of streaks and blotches. A yel- 
lowness sometimes attends a favorable crisis in severe cases. 
When the patient groans and mutters to himself, and answers 
indistinctly, whilst at the same time the eye appears dull, 
languid, watery, bloodshot, vacant and staring, death may 
be considered as not far distant. Towards the fatai termi- 
nation, the sensibility of the eye diminishes, and the patient 
lies with them half closed, in a comatose state of insensibili- 
ty. The cornea loses its brilliancy, from the want of mois- 
ture, and from the failure of the circulation in its vessels, and 
appears dim, shrunk and wrinkled. Life, for a lime, seems to 
vanish, again the pulse becomes perceptible. Sometimes the 
patient is sensible of his approaching fate 5 and even where 
the faith of religion is wanting, with a degree of philosophi- 
cal composure, bordering on stoicism, he meets deaiii with 
indifference, and with real or apparent resignation. 

In some instances, towards the fatal close of this disease, 
the absence of fever, and the coldness of the body, to those 



Of the Symptoms of Fever: 233 

unacquainted with the disorder, afford a deceitful progno- 
sis. The patient when spoken to, says he is better, being 
unconscious of pain or distress, and the attendants are flat- 
tered with the delusive hope of his recovery ; a few hours 
convince them of their error ; the patient occasionally dis- 
charges from his stomach, by eructation scarcely amounting 
to vomiting, a dark coffee colored fluid, or greenish black, 
mixed with dark grumous, or flaky matter ; the pulse be- 
comes weak, small and intermitting ; the extremities cold — * 
black discharges, sometimes consisting almost entirely of 
unmixed blooo^ from the ruptured extremities of the vessels, 
take place without the patients consciousness; the insensi- 
bility increases, and life imperceptibly vanishes, or a violent 
convulsion closes the scene. 

The disease when lighter in degree, as it generally is with 
the natives, and those who for some years have been accus- 
tomed to the climate, frequently assumes the form of a double 
tortian, with similar paroxysms on alternate days ; the lighter 
paroxysm comes on, perhaps, in the morning, and remits in 
the evening ; the other, or more considerable paroxysm, 
comes on in the evening, and affords but little remission till 
the next morning. In this particular, however, there is 
great variety, the accession sometimes anticipating, and at 
others postponing. The patient is scarcely ever entirely 
free from fever, and the paroxysms are frequently very se- 
vere. Sometimes after an imperfect remission it attacks 
with the symptoms of a distinct intermittent. The patient 
is seized with rigors increasing to a violent degree of cold 
shivering, severe pains in the limbs, and sickness at the 
stomach ; towards the decline of the cold stage, a violent 
vomiting comes on, and often proves very distressing. Pvlore 
frequently, however, in this form of the disease, after an 
imperfect remission, the paroxysm is renewed with a slight 
chill, succeeded by a vomiting of mucous and bilious mat- 
ter ; the hot stage runs high ; the pulse is frequent, strong 
and full ; there is a great determination to the head, the 
arteries of which beat violently, and the pain of which 
is severe ; great anxiety prevails ; the patient tosses his 
body about in different positions, unable to find relief in 
any situation ; a distressing heat pervades the surface of 
the body, and the mouth is dry and parched ; an insatiable 
thirst prevails, the patient drinks incessantly, and frequent- 
ly the stomach, from its irritability, rejects the fluids taken 
in, more especially when the drink is swallowed in any con- 
siderable quantity at a time. A clammy viscid saliva col- 
lects in the mouth, and obliges the patient to keep constant- 



j$3$ Of the Symptoms of Fever. 

ly spitting. The remission in this form of the disease is 
seldom sufficient to permit the patient to leave his bed. — 
The tongue at length, becomes covered with a moist thick, 
purple, or blackish fur; the body is greatly emaciated, and 
the general debility extreme. The patient is, in this way, 
sometimes worn out by the repetition of the paroxysms, or 
carried off at an earlier period by their violence. This 
form of the complaint is very apt to prove obstinate and 
tedious. The body sometimes turns yellow. 

There is a form of this disease attended with some vari- 
ety, with which strangers to the climate are affected. The 
patient is first attacked with pain in the head and back ; the 
pulse is frequent and strong, and the tongue white and fur- 
red ; the pulse, though increased in frequency, is often 
small and tense. Evident remissions and exacerbations 
take place at intervals ; the exacerbations are particularly 
severe in the evening. The skin is withered, dry, parched, 
and constricted ; a general pain and distress pervades the 
body; the tongue is either covered slightly with a white 
fur, or clean, red and moist, without the appearance of pa- 
pillae ; the taste is vitiated or destroyed ; a degree of anx- 
iety and oppression is felt at the precordia ; but the nausea 
is not, perhaps, distressing, nor is the vomiting frequent or 
considerable; the hearing becomes obtuse; the intellect 
deranged ; delirium takes place, or the patient is affected 
with stupor or coma ; the urine is secreted in small quanti- 
ty : the bowels are constipated, and ail the secretions are 
in a greater or less degree suppressed : as the disease ad- 
vances, the tongue assumes a brownish or blackish colour; 
sometimes the blackness extends in two parallel lines, about 
the width of the finger, on each side of the tongue. The 
pulse becomes more frequent, tense and receding ; the 
countenance sallow, withered and inexpressive; the eye 
watery and languid, or red and wild in its appearance.— 
Yellowness does not always appear upon the body, nor is it 
essentially connected as a symptom of the disease : in many 
cases of fatal termination, it is entirely absent, and it fre- 
quently appears in others of a favorable aspect; in either 
case, the yellowness is not generally perceptible till the fe- 
brile action has in some degree abated. 

To be more particular, it will not be improper to notice 
the more erratic and less ordinary symptoms, and such as 
have not fallen within the scope of the preceding catalogue. 

In the bilious fever, in its most agravated state, as it oc- 
curs in summer, we frequently meet with an irregular and 
intermitting pulse, somesimes moderately soft and full; at 



@f the Symptoms of Fever. 237 

others, the artery upon the application of the finger, is tense 
and wiery, and upon being pressed upon the tendons of the 
wrist, conveys a peculiar sensation, of which I can give no 
better idea than by comparing it to the feel of sand mixed 
with the blood, and gliding through the artery in a sort of 
hurried, rough, jerking and irregular manner; the pulse 
sometimes intermitting every fourth or sixth beat, for the 
space of two or three pulsations. In this intermitting pulse, 
there appears to be in some instances, a local affection of 
the vital organs, as the heart or lungs, with a considerable 
determination to particular parts, which become impeded 
and obstructed in their functions. This state of the pulse, 
though observed chiefly in the more aggravated forms of fe- 
ver, is not always fatal. 

In some, there is a violent pulsatipn in the head, accom- 
panied with a pain darting from temple to temple, or from 
the forehead to the occiput, and is sometimes particularly 
distressing whenever the patient lays himself in a horizontal 
position. I have known these symptoms connected with( 
a general paralytic affection of the whole body, which dis- 
appeared as the symptoms approached a more regular form, 
jn the full developement of a febrile character. Sometimes 
the tongue becomes red, smooth, dry, hard and stiff, as if 
seared with a hot iron, without the appearance of papillae, 
seeming evidently shrivelled and contracted in its dimen- 
sions, and itis with pain and difficulty that it is protruded from 
the mouth. This appearance, as far as I have been able to 
ascertain, denotes great derangement of the internal viscera, 
inflammation of the stamach, or engorgement of the lungs, 
and is connected with a constricted state of the skin ; the 
patient experiences great anxiety and restlessness, with 
sickness and oppression of the stomach. In some cases, 
large round worms are brought away by vomiting, with but 
little straining. In others, the tongue is covered with a 
slimy and greenish yellow fur, whilst bilious and bloody 
matter is passed by stool ; this state is attended with much 
prostration of the system; the patient experiences great 
misery and general distress, with severe pain in the bead ; 
the eyes are red and dull, sometimes squinting, and filled 
with whitish purulent matter. Some are affected with 
stranguary and suppression of urine, which continue through 
the hot stage. A fulness and sense of distention of the 
forehead, as if the head were inflated, are sometimes com- 
plained of. At various times during the remission of the 
fever, the morbific cause seems suddenly to translate itself 
to the bowels, producing excruciating pains in the lowej* 



23& Of the Symptoms of Fever. 

part of the abdomen, with much griping and scanty evaeua- 
lions of bilious, watery, mucous and bloody matter, some- 
times variously mixed and blended. In some instances, the 
patients are seized with hysterical and hypochondriacal af- 
fections. These are most apt to take place when there have 
been much preceding suffering and exhaustion of the strength 
and powers of the nervous system. In these cases, the pa- 
tient will give vent to his inexpressible distress in loud 
screaming, then again he becomes silent, stupid, and coma- 
tose ; if spoken to, he answers short and in monosyllables, 
or continues talking with delirious rant and incoherency. 

It is not very unusual to observe a patient affected with 
the greatest degree of alarm, despondency and apprehen- 
sion ; tortured with all the visionary phantoms and horrible 
apparitions of a distempered imagination ; sometimes fan- 
cying himself dead, strangely metamorphosed, or about to 
be devoured by some horrid monster, which haunts his bed 
in a threatening attitude, and the most terrific form. It is 
in vain to attempt to arouse him from his melancholy gloom, 
or to fortify his mind against the objects of his alarm and 
apprehension. 

In some, the surface of the body is extremely tender, sore 
and painful. 

But the most malignant fevers are not always those of 
the summer season. The worst bilious cases I have ever 
seen, have happened in the months of November and De- 
cember. In such cases, the symptoms vary considerably 
from those of the preceding months. The inflammatory 
action is shorter, and runs more rapidly into the typhoid 
state. It is further distinguished by the disposition which 
exists to local affections of the internal viscera, as the brain, 
lungs, stomach, bowels, &c. The fever is also more diver? 
sified in its appearance, and attacks under a greater variety 
of forms, than the bilious inflammatory fever of the summer 
months. Sometimes the febrile excitement is high ; the 
vibration of the arteries violent, strong and full, propelling 
the blood with accelerated impetus into every gland and 
viscus of the body. The face is flushed, the eyes watery 
and inflamed; the respiration anxious and oppressed ; but 
these symptoms are as short as they are violent ; in the 
course of ten or twelve hours the pulso loses its strength and 
fulness, and falls to the natural standard, or even below it. 
In other instances, there is scarcely any change in the state 
of the pulse from that of health, nor is the warmth of the 
body increased above its natural temperature, and some- 
times falls below it. J^ature, in this instance, seems to ty$ 



Of the Symptoms of Fever. 239 

completely overpowered and oppressed, without the strength 
and elasticity of resistance. The inexperienced physician 
is often deceived by these delusive symptoms, which, how- 
ever promising and free from danger they may at first ap- 
pear, are the sure harbingers of impending danger. 

This form of fever, in ordinary cases, attacks with pains 
sometimes fixed, sometimes wandering, often universal, like 
a general rheumatic affection, in others local : in a few, the 
attack assumes the symptoms of a catarrh, with a great de- 
gree of hoarseness ; the parts most frequently affected, in 
such cases, are the lungs and pleura. The pain in the bead, 
back and limbs, is at first severe. The patient complains 
of great sickness and oppression, and general distress ; there 
is a frequent vomiting at first, of dark coloured bilious mat- 
ter, afterwards of mucus ; it is with difficulty that any thing 
can be retained upon the stomach; such is the weakness 
and irritability of this organ, that the blandest, as well as 
the most cordial substances, are oppressive and nauseating. 
Not un frequently the patient is also affected with a flux or 
dysentery, attended with the discharge of black and very 
offensive matter. The pulse, in the progress of the dis- 
ease, is either soft, feeble and frequent, or but little accele- 
rated and almost imperceptible, and sometimes preternatur- 
al!)' slow and languid. The tongue at first is generally- 
clean and moist ? on the second day it becomes slightly fur- 
red, appearing of a dull lead colour, and not unfrequently it 
continues clean and moist till the final termination of the 
disorder in recovery or death. In others, the coat upon 
its surface becomes gradually darker and thicker, generally 
moist, glutinous and slimy ; the dark sordes become at 
length perfectly black, extending to the mouth and adhering 
to the lips. I have seen this black matter nearly a quarter 
of an inch thick, ami so dry and hard as to render the tongue 
almost immoveable ; sometimes this crust cracks into fis- 
sures. The thirst is sometimes great, sometimes moderate, 
depending much upon the state and condition of the skin; 
where this is moist, there is little or no thirst, where dry 
and constricted, (he thirst is more considerable; though in 
these cases it does not always occur, owing, perhaps, to an 
insensibility in the patient to the peiception of natural appe- 
tites, and a destruction of the function in the organ of taste. 
The skin is commonly dry, stiff and impervious to the per- 
spiration, and entirely destitute of moisture : in persons of 
full and sanguine habits, it assumes a dark red colour, exhi- 
biting the appearance as if it had been bruised and beaten. 
When a moisture does appear, it is cold and greasy, and 



24-0- Of the Symptoms of Fever. 

confined to particular parts of the body. In a few, the skin 
is warm, soft and moist. Sub-saltus tendinum and twitch- 
ing of the muscles, jerking of the limbs, the patient extend- 
ing his arms to fanciful objects before him, picking of the 
bed clothes, as if with the design of removing vermin, deli- 
rium, and other nervous symptoms come on early. The 
eyes are red, dull, vacant and inanimate, or glaring with the 
dismal expression of hopeless misery and mental agony : the 
countenance sometimes exhibiting a strange and savage 
look, as if the patient's mind was laboring with the thought 
of intended suicide or secret murder. He is either insen- 
sible, with the vacant, wandering, stupid stare of an idiot, 
mumbling and muttering, but articulating nothing ; or le- 
thargic and comatose, with closed eyes and deep respira- 
tion •, when roused from his stupor, he opens his eyes with 
affright or reluctance, mutters a few words indistinctly to 
the questions that are put to him, then falls again into his 
unnatural slumber. In others the derangement assumes a 
wilder form ; the time is divided, with the patient, between 
perfect composure, in which he scarcely seems to breathe, 
and the incoherent raving of a deranged and distressed ima- 
gination ; becoming sometimes quite sentimental and the- 
atrical in manner and expression. The pulse here is but 
little altered, except in a diminution of strength from the 
healthy state ; the body is cool, and the hands and feet be- 
low their natural temperature. Moments of recollection 
sometimes occur, like a flash of lightning through the black 
clouds of night; and a ray of intellect, now and then, darts 
across the mind, and renders the patient conscious of his 
own situation and of surrounding objects; then again the 
understanding is clouded, and every faculty of intellect bu- 
ried in stupor, or dissipated in the erratic vagaries of a dis- 
tempered fancy. When the nervous system is less oppress- 
ed, the patient compares his feelings to those produced by 
intoxication j " I feel," said a patient to me, ''as if I were 
half drunk." Hiccup frequently comes on even at the 
commencement of the disease, often returning at short in- 
tervals. At a period somewhat advanced, varying in differ- 
ent patients, a yellowness sometimes overspreads the body, 
increasing from a light to a deep colour. The stools, which 
at first were dark green or blackish like tar, become mixed 
with blood. As the disease advances towards the fatal ter- 
mination, the proportion of blood increases, appearing 
grumous and dissolved, and coming from the patient without 
bis consciousness. The patient sometimes compares his 
sensations to that of a large ball, pressing upon the cesopha- 



Of th t Symptoms of FHet. 1 42 

;.. and rendering deglutition difficult. Some patients 
are seized with horror at the Sight of liquids, and are with 
much difficulty prevailed upon to tasie them. When re- 
ceived into the mouth they are commonly thrown oat again, 
either voluntarily, or by a couvuUive motion of the pha- 
rynx, so that very little, if any, is received into the stomach. 
In other i 'Stances, the patient desires tp drink;, biuj Rj una- 
ble to swallow. I have known patients in &\ti&\ instances 
oi lever, lind no difficulty in swallowr „ ; lybaieyer was pre- 
sented to them, even in the last moments pf existence.*^ 
Haemorrhagy not un frequently takes place from (he bowels; 
land die vessels of the lung s , themselves, so n qtimeS give 
way, and the patient js in danger of suifbeation. Without 
any premonitory symptoms, convulsions sometimes seize 
upon the patient, and agitate the body nearly to dissolu- 
tion ; from this shock, the progress is sure and rapid. For 
some moments, the patient is deprived of the appearance of 
life.; at length the breathing returns ; the pulse, in some 
e'ee, revives, but the intellect is permanently deranged ; 
the patient h (i s with, his eyes half closed, in a slate of stupor 
and insensibility, or if any consciousness remains, it is only 
alive to misery : he is perpetually groaning, sighing and 
gnashing his teeth. Sometimes he is oppressed with an 
effusion of lymph ; respiration is rattling, slow, and labori- 
ous; the intervals of breathing become longer, and life is 
terminated by an expiring gasp. 

To an inexperienced person it might sometimes be diffi- 
cult to distinguish a state of convalescence or solution of the 
fever, from (he collapse of typhus. I have, myself, in the 
early part of my practice, been, in this way, sometimes de- 
ceived to the loss of my patients. Upon close examination, 
however, the distinction is not difficult; for though in the 
typhus, or asthenic state of fever, the skin may be cool, the 
tongue clean and moist, as it sometimes is. and the pulse 
soft and slow, or but little increased in frequency; yet the 
patient is often restless and anxious, his countenance is 
sunk and dejected, the evacuations by stool and urine con- 
tinue unchanged ; the stools are dark, black, perhaps bloo- 
dy, and offensive : or the bowels remain obstinately constipa- 
ted : the urine is high coloured ; the skin is dry and shrunk, 
of unequal temperature in different parts, the warmth in 
the extremities being reduced below the natural standard, 
and increased in the region of the stomach and bowels, or 



::: According to Portal, a difficulty of swallowing and of speaking fre- 
q we:.: ly depends on engorgement in the cervical portion of the spinal marrow. 



242' Of the Symptoms of Fevev. 

the surface is covered with partial clammy sweats. The 
tongue in this state, is often foul and black, and more dry 
than in convalescence, though not invariably, where it is 
dry. crisp and horny, there is less liability to mistake. The 
general prostration is here much greater than after a solu- 
tion of the fever, and there is no inclination for food of any 
description, as there often is after a crisis. 

It is only in the early stage of the typhus or asthenic state 
of fever, that there can beany deception, for the increasing 
debility, the tremors and sub sultus tendinum, the alienation 
of mind, coma, &c. which speedily succeed, unless prevent- 
ed by appropriate means, soon remove all doubt as to the 
character and tendency of the symptoms. 

Enlargement and chronic inflammation of the liver and 
spleen, are common consequences of the fevers here de- 
scribed. 

The doctrine of critical days has been much agitated 
among physicians ever since the time of Hippocrates ; but, 
however plausible it may be in theory, I have reason to 
think it is destitute of any solid foundation. Thus, during 
the same season, and in the same neighborhood, we fre- 
quently observe an attack of bilious fever to terminate com- 
pletely in twenty-four hours by proper and energetic treat- 
ment ; and in others, the disease is of various and uncertain 
continuance, from one week to two and three months.- — 
When the disease continues thus long, however, it should 
rather be considered, perhaps, as fresh renewals of the dis- 
order, than a continuation of the same fever. Though I 
have often known it to continue with very little interrup- 
tion or abatement for twenty or thirty, and even forty days ; 
the fever generally remitting once or twice in the course of 
the twenty-four hours. 



Prognosis of Endemic Fever. .24-3 

CHAPTER XI. 
PROGNOSIS OF ENDEMIC FEVER. 



With regard to the prognosis, this is to be gathered 
from the nature of the prevailing epidemic, the habit and 
constitution of the patient, and the appearance of the symp- 
toms. 

In genera], the more severe and longer the chill at the 
invasion of the paroxysms, the less dangerous is the disease. 

When the fever comes on suddenly without any premoni- 
tory symptoms, the disease is more dangerous than when 
less sudden in its attack. 

In old persons, who have been accustomed to the free use 
of spirituous liquors, the disease is generally of an unfavora- 
ble nature. In such, symptoms of collapse come on early ; 
the irritability of the stomach is excessive ; the vomiting 
almost incessant, and the insensibility to stimuli so great, that 
nothing seems to have any effect. There is often, in such 
persons, an absence of fever, or at least of an increase of 
temperature; the body and extremities being preternatur- 
ally cool; the surface dead, slippery, and clay like to the 
touch ; the tongue and mouth are covered with a stooty fur ; 
the pulse is feeble and frequent, or slow, creeping and re- 
ceding from the touch. When the invasion has been sud- 
den and violent, and the powers of life appear to be op- 
pressed and subdued beyond the ability of resistance, and 
where coma and insensibility come on early, the disease, in 
general, hastens rapidly to a fatal termination. 

A state of pregnancy is unfavorable to women laboring 
under bilious fever ; though not always fatal, the disease is 
thereby rendered more severe and malignant. Hippocra- 
tes says that u any acute disease attacking pregnant women 
is fatal."* Dr. Russel says the plague was fatal to preg- 
nant women, or at least, for the most part, produced abor- 
tion. Women near their time, died almost without excep- 
tion, surviving delivery only a few hours. Some were de- 

* Mulierem utero gerentem morbo quopiam acuto corripi, Iethale,-c 
Hippoc. Alph. 



244 Prognosis of Endemic Fever, 

livered in the agonies of death ; and the infant sometimes 
bore evident marks of infection.* 

A state of corpulency and fatness is unfavorable in bilious 
fever. In fat persons laboring undci fever, the circulation 
is weak, languid, oppressed "and confined.: apparently una- 
ble to reach the, surface and extremities; the pulse at the 
wrist is feeble? tremulous, and scarcely perceptible, reced- 
ing from the touch, and affording no resistance, The sur- 
face is moist, cool and doughy to the feci .; or if the central 
parts are warm, the extremities are generally cool. In such 
persons the accumulation of fat seems to straighten and con- 
fine the blood vessels, acting with a compressing force upon 
their sides, and diminishing their capacities, whilst at the 
same time the blood is accumulated in the large internal 
vessels of the body, and overloads the heart with the dark 
carbonized and impure blood ; occasioned, in part, by the 
imperfect action of the lungs. 

The state of the skin, in connexion with other symptoms, 
is one of the best criterions ; when this is soft, moist, mode- 
rately warm, free from any clammy or slippery feel ; the 
extremities at the same time being warm, the intellect clear, 
and the pulse sof{ and free horn languor and obstruction, 
the event is hopeful. It the evening exacerbations are fol- 
lowed by a general flow of warm and fluid perspiration, 
leaving the skin moist, free and open, though the other symp- 
toms should be more unfavorable, we have reason to hope 
for a happy termination. On the contrary, where she per- 
spiration is partial, appearing chiefly on the superior parts 
of the body, as on the forehead, neck and breast ; and when 
the skin, upon being touched, feels cold and slippery, to- 
gether with a coldness of the extremities, we may nr, 
ticate an unfavorable event. t The same, also, may be ap- 
prehended from a dry, husky, and constricted state of the 
surface; or when the latter appears livid, diversified -with 
purple blotches, or covered with petechia. 

Though a yellowness of the body is not uncommon in this 
disease, and although it sometimes appears in cases that are 
not remarkably malignant, yet, generally speaking, it marks 
a disease of considerable severity; and when this yellow- 
ness is interspersed with livid or purple spots, or with streaks 
and blotches, we may with considerable certainty calculate 

* Russel on the Plague, p. 95. 

+ Sudor optimus sane qui febrain die judicatione tollit. Utilis autem et 
qui allevat. Malus vero irigidus, et ubi caput duntaxat et cervix imudat. 
Nam et temporis diutemitatem et pericuhun denunciat. Eipvoc. Coac. 
Prmnot. p. 207. 



Prognosis of Endemic Fever, 24£ 

upon a fatal termination: convulsions, under these circum- 
stances, are liable to take place at an) moment, even when 
we might otherwise consider the patient free fiem danger. 
Yellowness is most frequently observed in emigrants from a 
northern climate* 

When the teeth are dry, as if they had been exposed to 
the wind, or are covered with a blade, viscid, and glary n ,-= 
ter that is with difficulty rubbed off, the disease may be con- 
sidered of a malignant.cbaracter.* 

When the pulse is not much accelerated in frequency and 
force ; or when from small, frequent and inlermittii g. it 
becomes regular, less frequent, and more full, the symptom 
is favorable ; a small, slow, irregular and intermitting pulse, 
indicates danger. Though the pulse be intermitting, yet if 
the other symptoms are not alarming, this circumstance 
alone is not to be considered dangerous. Should it occur, 
however, after the fifth or seventh day, together with an ex- 
hausted state of the system, debility of vital action, and a 
yellowness of the skin, it is to be regarded in an unfavorable 

The appearance of the tongue, together with the other 
symptoms, assists in forming the prognosis. Whtn it is 
covered with a white fur, it is generally a favorable sign, as 
indicating a degree of activity and vigor in the circulation, 
not liable to be suddenly and alarmingly depressed by the 
means that are employed to subdue the febrile action, — * 
Wberiji on the contrary, the febrile excitement is considera- 
ble, and the tongue is moist and clean, we have reason to 
apprehend the early appearance of typhoid symptoms. — • 
When, however, this occurs in sanguine and plethoric hab- 
its, the danger is less, the strength of action being kepi up 
by the natural vigor of the constitution. A smooth, dry,, 
sinning, fiery red tongue, without the appearance of papil- 
lae, in acute fevers, is a dangerous indication, arid is fre- 
quently connected with some local affection; when from 
the commencement the symptoms are less acute, the disease 
is protracted to a considerable length* Such a state of the 
tongue is often accompanied with a red, watery and des- 
ponding eye. In the advanced period of the disease, the 



* Quibus per febres ad dentes glutinosus humor obnascitur, its vehemen- 
tiores fiur.t U bres. Hippoc. Aph. 53. Baglivi, speaking of the teeth, ob- 
serves, that while teeth, it) general, show a good chylification or a habitual 
sobriety ; that when they grow soon foul and glaj y, the digestion is weak. 
He adds, " Take care of the teeth that ycu may digest well, and live long : 
they are the kitchen of the chyle." 



4246* Frognosis of Endemic Fever. 

tongue assumes a darker colour; if at the same time the 
skin is soft and perspirable, the appearance maybe regard- 
ed as free from danger ; but if the vomiting has been severe, 
and the strength of the circulation exhausted and worn out, 
a black, hard tongue, with black sordes adhering to the 
teeth, lips, and angles of the mouth, may be looked upon as 
harbingers of approaching dissolution. 

Delirium, when unattended with stupor, is not dangerous ; 
but when the patient is alternately delirious and comatose, 
the prognosis is unfavorable. 

Deafness, occurring in acute bilious fever, is generally a 
favorable sign; though I have known some tedious and lin- 
gering recoveries, I never lost a patient where this symp- 
tom had taken place. Patients affected with deafness, ac- 
cording to my observation, are longer convalescent than 
others * 

Vomiting, when frequent and unattended by a discharge 
of bile, is unfavorable. At the invasion of fever, it is a 
common symptom; and as far as it is occasioned by the 
presence of bile, is unattended with any considerable dan- 
ger; but when after the complete evacuation of all bilious 
matters the vomiting still continues, with the discharge 
merely of the drink received, or of viscid mucus, it is not 
free from danger. Under these circumstances, the strength 
is rapid!) exhausted ; the body becomes cold, the pulse fee- 
ble, and a cold clammy sweat is forced out upon the sur- 
face. When vomiting occurs in the advanced period from 
the weakness and irritability of the stomach, by which a 
dark coffee colored fluid, mixed with flaky matter, is dis- 
charged, the case may be considered hopeless. 

A great degree of sickness and oppression at the stomach, 
without the power of vomiting, is an unfavorable symptom. 

When the evacuations by stool are black, copious, and 
extremely offensive, or occurring in the advanced stage of 
the disease, they are unfavorable ; if at an early period they 
mark a disease of considerable violence and of uncertain 
issue : if mixed with blood, or when they consist almost en- 
tirely of this fluid, they generally indicate a fatal termina- 
tion.! When there are bloody stools, like the washing of 
raw beef, provided the other symptoms are favorable, the 

* Quibus per iehris anres obsurduerunt, sanguis ex naribus perfluens, 
aut alvus exturbala, morbus solvit. Hippoc JQpfi. 60, lib. iv. sec, 3. 

f Alvi excrementum nigrum vilut sanguis, etcum febre, maloest. Mala 
item quaecunque vaiia, et quae bili abundi sunt saturata. Hippoc Coac< 
Prmn&t. 



Prog?iesis of Endemic Fever* 24# 

former mav be considered as free from danger, and I have 
; £ions observed them to mark a solution or 
crisis er: but when these bloody discharges are 

ace i with other typhoid symptoms, are black and 

s?ive, appearing to consist entirely of grumous blood, 
fnay be considered as indicating a fatal termination.* 
at and obstinate constipation of the bowels, the pa- 
jomplaining that the substances taken proceed no fur- 
; than the entrance of the stomach, occasioning there 
rise of fulness, anxiety and oppression, which, after a 
>ng,er or a shorter time occasion their rejection ; the stools 
lie same time when produced either by cathartics, which 
lifficulty are made to operate, or by the use of 
:i ins, are small in quantity, appearing of a light clay 
A membranous or flaky looking substance, more like 
the inner coat of the intestines than any excrementitious 
matter of their contents ; this symptom, though not abso- 
lutely dangerous, generally marks an aggravated form of 
the disease ; and more frequently occurs in young, robust 
and sanguine constitutions* or in persons of full and pletho- 
ric habits. 

If the siools have been dark, bilious, copious and offen- 
sive from the first, and continue so through the progress of 
the complaint, the ca?e is more favorable than when they 
become light clay coloured, small and less offensive ; when 
from the latter condition they again become copious," dark 
and bilious, they generally mark a typhoid or asthenic state 
of the disease, and are not free from danger; when the 
bloody discharges are occasioned by griping and other dys- 
enteric symptoms, they do not prognosticate any immediate 
danger. 

Involuntary discharges from the alimentary canal, wheth- 
er of blood or other matters, may generally be regarded as 
a fatal symptom. I have known this to happen, however, 
in the course of the paroxysm, in which, from the com- 
mencement, there was a complete abolition of intellect, 
without being followed by fatal consequences. But when 
involuntary discharges take place in the advanced or asthe- 
nic stage of fever, without being referable to any sudden 
abolition of intellect, stupor and unconsciousness, the prog- 
nosis is unfavorable ; as also when such evacuations take 
place with the patient's consciousness, but when he is una- 
ble to go to stool in an erect position, the case, generally, 

* In fevribus non inlermuttintibus excreliones lividae, cruentae, bilicrsa 
Vt graviJcstes omnca aialae. Aj>h. 7], lib. vii. sec. 7. Op. p. 2fc 



248 Prognosis of Endemic Fever. 

may be considered hopeless. The patient complaining of 
great heat, when the skin, to -the touch of another person, 
seems below or not to exceed the natural temperature, at 
the same time that he is aff jeted with great thirst and de- 
sire for cold water and cold air, are symptoms which may 
be looked upon as unfavorable; more especially if great 
restlessness prevails, with a frequent inclination and effort 
to get out of bed and to escape from confinement. 

The face and lips appearing extremely pale, inanimate, 
and bloodless — or livid and dejected, with an expression of 
pain or anxiety, is unfavorable. 

When the patient faints upon being raised to an erect po- 
sition, the danger is great. 

Suppression of urine sometimes occurs, but unless in the 
advanced stage of the disease does not indicate danger, nor 
is it commonly of long continuance. A copious secretion 
of urine is a favorable symptom. In general, when the fe- 
ver has a tendency to a favorable crisis, the urine is of a saf- 
fron colour. The urine in hot climates seldom deposits any 
sediment, which is probably owing to its being more acri- 
monious and alkaline ; for upon adding a little lime juice or 
vinegar to it, a sediment takes place, as in the urine of fe- 
brile patients in northern latitudes.* 



* The older physicians were very curious in their examinations of the 
appearance of the urine ; and it may be remarked, that during- the par- 
oxym iis colour is lighter, during the remission it is reddish, or the colour 
of strong ley, but without sediment ; its assuming a light straw colonr, and 
depositing a brick dust coloured or branny and flocuient sediment, indicates 
a crisis or solution of the fever. "Urine,' 1 says Boerhaa-ve, "which is 
thin and not disposed to settle, that is white, thin and watery, or straw 
•coloured, and not turbid at times; or urine that is always turbid, and never 
settles, shows in many acute fevers retarded coction, much acidity, a diffi- 
cult crisis, a long disease, and the greatest danger; and in inflammatory 
fevers of the mo-t acute sort, almost certainly portends death ; in moderate- 
ly acute fevers it indicates a long and troublesome disease." Boerhanvt\i 
Institutes, sec. i016. "In slow fevers," says Dr. Fovdyce, " ihe urine is 
pale, in the increase of the fever the sediment is sometimes thick, rough, 
full of scales, and of a whitish colour; this jurfucaceous appearance never 
fails to mark a long disease and a severe struggle, but manageable bygrtat 
attention. How much contempt should light on those careless or uncon- 
scientious men who come and go to and from the bed-sides of their patients, 
in every sort of fever, without attending to the urine, or paying the least 
regard either to its flattering or fatal phenomena. Foresee on. Ftver, p. 65. 
" The change in the humo'irs," says Senac, "•appears also in the urine it- 
self. Daring the febrile action, that fluid is flame coloured, but as the par- 
oxysm declines, becoming thick, frothy and very red, it puts on at length 
a brick dust colour. This colour appears in particular in the sediment, which 
is generally copious. * * Indeed, there is no solid reason to believe that the 
system is free from the fomes of the fever, while the urine retains its late- 
ritious colour, or is in any measure tinctured with red. This phencmenor 



Prognosis of Endemic Fever. 249 

Hiccup is a common symptom, from the presence of 
which alone little can be determined ; since it as often at* 
tends cases of recovery, as it appears among the fatal symp- 
toms towards the termination. When the other symptoms 
are not alarming, when the intellect is entire and unimpair- 
ed, the patient free from coma or stupor, from prostration 
or great debility, this symptom does not indicate danger. 
But when the vital powers are much exhausted or oppress- 
ed, the surface cold, the intellect deranged, or the patient is 
affected with stupor, it may be looked upon as the precur- 
sory symptom of a fatal termination. 

Pain and swelling of the hypochondria are ominous indi- 
cations.* 

Such are the principal circumstances, which in the course 
of my practice have led me to judge of the event of the dis- 
orders with which they were connected. Different symp- 
toms are noticed by different authors; but as every physi- 
cian is more particularly interested in the diseases of his 
own country, upon a subject where so much might be said 
and still much be left untold, in giving an account of the 



does not prove fallacious only ia cases where the sick labour under some 
hepstic affection. If at any time the urine should exhibit a white matter 
settling- copiously to the bottom of the vessel, this is to be considered as a 
favorable symptom, and even a sign of crisis in the disease. I must con- 
fess, however, that (his phenomenon has but seldom fallen under my no- 
tice. Scnac en the hidden Nature and Treatment of Intermitting and Re- 
mitting Fever, p. 133. 

* " To patients in the prime of life," says Senac, " the cold fit of an in- 
termittent is not often dangerous ; but to persons advanced in years, it is 
very frequently so. The danger arising from the hot state of fever is not 
so great." Senac on ihe hidden Nature and Treatment of Intermitting and 
Remitting Fevers, p. 128. Perhaps the danger in the cold stage of remit- 
ting fever m aged persons and those much debilitated by sickness, is more 
dangerous than in the intermitting fever; more especially if the system has 
been much weakened by previous attacks. 1 have observed such patients, 
under these circumstances, die with stupor, coma, or derangement ; the vi- 
tal powers gradually declinitsg as the cold stage progressed, stimulants be- 
ing of no avail to rouse the declining vigor of the circulation, and bring 
about a react ; on. It is observed by Dr. Lind, however, that he never saw 
a patient die in the cold stage of fever, and that according to his observa- 
tion the hot stage was the most dangerous. The observations of Dr. Lind 
are as follows : i4 I never saw a person die in the cold fit, but have known 
several carried off in the hot one, by strong convulsions, a delirium, and 
other symptoms ; and am clearly of opinion, that ii is the hot fit, or fever, 
which most endangers the patient's life, and by its continuance, weakens 
and impairs his -whole habit of body." On the Diseases incidental to Euro- 
peans in Hot Climates. As it respects my own practice, I have generally 
found the sweating stage to be attended with the greatest danger, except 
when active remedies have been employed during the paroxysm, so as to 
occasion a sudden collapse or prostration before the regular and natural 
appearance of the perspiration. 



%50 Appearances on Dissection, 

symptoms forming the prognosis, I have confined my=elf to 
such as are connected with the fevers of the country, and 
such, more especially, as have come within the sphere of 
my observation. 



CHAPTER XII. 
APPEARANCES ON DISSECTION. 



The different organs and viscera of the body are liable to 
be affected in the endemic fevers of hot climates, leaving 
various traces of inflammation and congestion of blood, the 
consequences of violent excitement and local derangement. 

The brain is less frequently affected than the viscera of 
the thorax and abdomen. The former, however, is by no 
means exempt. This might be inferred from the head-ache, 
delirium and stupor with which the patient is frequently af- 
fected. When the febrile excitement has been high, the 
vessels of the brain are found distended with dark fluid 
bk)od ; yellow serum is sometimes found effused into the 
sinuses. Where the action has been languid, the brain is 
generally destitute of the traces of preceding inflammation ; 
appearing white, with an effusion of water into the ven- 
tricles. 

The heart is often found much enlarged, flaccid and dis- 
tended with black blood; sometimes containing polypous 
concretions, extending into the larger branches of the blood 
vessels connected with it. 

The lungs are frequently diseased ; sometimes their sub- 
stance seems to be destroyed, and the membranous cover- 
ing filled with grumous blood; in many instances they are 
preternaturally tender and easily lacerated. Sometimes, 
when there has been anj considerable degree of local affec- 
tion in the chest, they are consolidated into a firm substance 
resembling liver, and completely impervious to the air, ex- 
cept, perhaps, a very small portion which remains free from 
such obstruction. The lungs are frequently united to the 



Appearances on Dissection, %5t\ 

pleura costalis ; and in some instances ulcerations are dis- 
covered in their substance. On some occasions, effusions 
of yellow serum are found in the cavities of the thorax. 

The gall bladder is generally filled with dark coloured 
viscid bile, of the colour and consistence of tar or molasses ; 
sometimes this dark colour is owing to the bile being ex- 
tremely thick and inspissated, and when diffused thinly over 
the surface of the knife, it assumes a green colour : in other 
instances I have found the bile in the gall bladder perfectly 
black, under every aspect in which it might be viewed: — ■ 
the latter instances only show that the morbid process has 
made greater progress. 

The liver is particularly liable to suffer in bilious remit- 
ting or yellow fever, as also in the intermitting fever. Va- 
rious marks of derangement are discovered upon dissection* 
It is not unfrequently found much enlarged in its dimensions \ 
sometimes pale, and at others of a dark brown colour, with 
variegated spots or streaks throughout its substance. The 
veins are commonly distended with blood, and ulcerations 
are discovered beneath a healthy surface. In some it is in- 
durated, in others preternaturally tender and full of blood. 
Extensive adhesions are sometimes formed with the sur* 
rounding parts, as the duodenum, colon and diaphragm. 

The spleen is also liable to be affected ; being frequent- 
ly much enlarged ; sometimes it appears as a sack filled 
with blood ; and not unfrequently it is found indurated. 

The pancreas is sometimes ulcerated and enlarged. 

The internal coat of the stomach and intestines generally 
exhibits more or fewer traces of inflammation, the veins ap« 
pearing large, distended and livid. In those cases where 
there has been a vomiting and discharge by the bowels of a 
dark coifee coloured fluid, mixed with dark brown or black 
flaky matter, the same substance is discovered in the sto- 
mach and bowels after death. From what I have myself 
observed, I am inclined to consider this fluid, which goes 
by the name of the black vomit, as nothing more nor less 
than an altered secretion from the liver, or in other words, 
morbid bile, which finds its way into the stomach from the 
efforts of vomiting, or from the horizontal position of the 
body in bed, favoring its influx into this organ ; where it is, 
in some degree, decomposed ; the albuminous portion of the 
bile mixing with the fluids of the stomach and bowels, leav- 
ing the resinous matter free and unconfined, in the form 
of a black, or dark coloured powder, or rather flaky sub- 
stance, consisting of the resinous and carbonaceous portion 
of the bile, and which is discharged by vomiting and stool. 



252 Appearances on Dissection. 

It appears to be from the solution of the black bile in the 
stomach and bowels, that a dark brown, or coffee coloured 
complexion is given to the fluids of the primm vies. 

In the dissection of the bodies of those who died of the 
fever in Philadelphia in 1793, by Dr. Phj sick and Dr. Cath- 
rail, we are informed that the stomach appeared spotted in 
many places with extravasations, though free from appear- 
ances of inflammation. The inner surface of the intestines 
was inflamed; but what is more to our purpose, as showing 
that vitiated bile and the black vomit are the same thing, 
the stomach contained, as did also the intestines, a bUu :k 
liquor similar to that which had been discharged by vomiting 
and purging before death. "This black liquor," we are 
told, " appears clearly to be an altered secretion from the 
liver; for a fluid in all respects of the same quality was 
found in the gall bladder. This liquor was so acrid that it 
induced considerable inflammation and swelling on the op- 
erator's hands, which remained some days."'* T>r. Robert 
Jackson, speaking of the appearances on dissection, re- 
marks,! that " where black vomiting has taken place, the 
gall bladder is more or less full of bile, often black and thick 
like tar or molasses; the gall ducts are enlarged, and the 
bile is traced into the duodenum, tinging -with its sooty co- 
lour, the contents of the stomach and intestines." Similar 
observations have been made by others; and yet it has 
been contended by some physicians that the black vomit is 
an altered secretion from the stomach itself, -and in which 
the bile has no concern; occasioned, as is supposed, by a 
mixture of the broken and extravasated globules of the 
blood, blended with the other vitiated secretions of the 
stomach. The arguments in support of this opinion are, 
1. That unlike the bile, the black vomit is destitute of bit- 
terness : 2. The bile, though appearing black, yet when 
spread upon a thin surface, appears of a yellowish green: 
3. The gall bladder being sometimes small and contracted, 
containing but little bile, whilst at the same time a very 
considerable quantity of black vomit has been discovered in 
the stomach after death: 4. The gallbladder containing 
sometimes a colourless fluid, whilst at the same time black 
vomit was found in the stomach. J To the first objection it 
may be answered, that the stomach possesses the power of 
changing the sensible properties of substances received into 

* Rush's Inq. & Obs. Vol. III. p. 73-4. 

t Outline of the History and Cure of Fever, p. 211. 

% See the Philad. Med. Mus. Vol. IV. p, 26. 



Jppearances on Dissection. 253 

and contained in it. The second objection is not supported 
by facts ; for others, as well as myself, have seen the bile in 
the gall bladder perfectly black, however thinly diffused 
over a clean while surface ; and, were it otherwise, it is very 
probable that the stomach might possess the power of rhan- 
ging its colour and appearance. The third objectien proves 
nothing: for the probability is, that the bile is poured into 
the duodenum and stomach nearly as fast as it is secreted. 
The circumstance of the fourth objection, is what I have 
myself never observed in bilious fever : it is true, that in 
protracted bowel complaints or dysenteries which have ter- 
minated fatally, I have sometimes found the gal! bladder 
filled with a transparent colourless fluid, but I have never 
seen any thing of this nature in bilious fever, and in this par- 
ticular the general experience of physicians corresponds 
with my own observation. That the black vomit is vitiated 
bile or a morbid secretion from the liver, appears from this: 
at the commencement of fever, great quantities of discolour- 
ed bile are discharged from the stomach and bowels, but no 
black vomit; as the disease advances, the bile changes to 
brown, olive, corbo, coffee coloured, and finally to black. — • 
The exhibition of a cathartic brings away great quantities of 
this brown, olive, or black matter, but no green or yellow 
bile, which it should do, were the bile and the black vomit 
two distinct and different fluids. 

The numerous appearances of local inflammation which 
are discovered upon dissection in the different viscera of 
the body, have led to the conclusion, that copious blood- 
letting is necessary for their removal. This opinion, how- 
ever, will appear less true than plausible, when it is recol- 
lected, that it is in fevers of the most malignant character, 
and in which typhoid or asthenic symptoms supervene at 
an early period, that these affections are most apt to take 
place. It is true that on many occasions these local inflam- 
mations are attended with considerable pain in the part af- 
fected ; but it is also equally true, that, in perhaps the great- 
er number of cases, the pain or uneasiness has been so ob- 
scure as to escape attention, and that even in instances 
which have ultimately proved fatal. Thus, an incipient in- 
flammation of the liver, commenced and produced by the 
fever, but which at first excited no attention, continues after 
the recovery from the {ever, and goes on increasing till it 
sometimes ends in suppuration. It w r as observed, likewise, 
by Dr. Chisholm, that of those who died of the pestilential 
fever in Grenada, in 1793, the lungs were found highly in- 
flamed, and of a livery texture and hue; "a circumstance. 



24<r Appearances on Dissection, 

the more extraordinary." he remarks, "as no symptom of 
a marked pulmonary affection could be perceived during 
the existence of the disease.* Instances are also recorded 
by Morgagni, Van Swieten, De Haen, Pringle and others, 
in which traces of considerable inflammation were discov- 
ered, though that had not been previously indicated by any 
degree of pain. 

These appearances of inflammation on dissection in ma- 
lignant diseases have been explained by Burserius in a man- 
ner different from the opinion commonly received. He as- 
cribes them to the dissolved state of the blood; and refers 
to Ludwig. Advers. Med. Prac. in support of his opinion. — - 
" For it is a well known fact," says he, " how much the 
death of patients has been accelerated by those who, de- 
ceived with the appearance of such false inflammations on 
dissection, to guard against or remove them, in malignant 
and putrid diseases of that kind have not hesitated to em- 
ploy copious and repeated bleeding."! 

It was long since remarked by Riverius, that "acute and 
malignant fevers scarcely ever occur unaccompanied by in- 
flammation in some one of the viscera." And he cautions 
us in another place, that we ought constantly to recollect, 
that all those fevers with which local inflammation is con- 
joined, are not symptomatic, but often idiopathic, and that 
the inflammation supervenes, not being the cause but Ihe 
consequence of the fever. i " Thus," he adds, " we fre- 
quently observe in practice, that patients labor under con- 
tinued fever for a day or two before pain of the side and 
other symptoms of pleurisy appear ; thus, also, many per- 
sons, on the third or fourth day of fever, fall into inflamma- 
tion of the brain, ?? &c.§ 

We are informed by Dr. Home, in his account of the yel- 
low fever of Jamaica, that he found in several dead bodies 
the liver enlarged and turgid with bile, and of a pale yellow 
colour. In some, the stomachs were inflamed, and marked 
with black spots of the size of a dollar. 

In the yellow fever, Dr. Jackson states, that the brain, 
upon dissection, appeared to be more or less affected in the 
majority of subjects who died in the acute state of the dis- 



* Chisholm's Letter to Haygarth, p. 136- 

t Burser. Prac. of Medicine, Vol. I. p. 69. 

^ Quae febram islam non efficit, sect Illi poiius succedaneum e?t. 

i Sic nobis frequenter in usu practico videre licet aegrotantos, ab initio 
iebri continua labor antes per unatn aut alteram diem, antiquam dolor lateris 
et alia pleuritidis signa appareunt : sic multi tertia vel quarta febris die in 
-leuritidem incidunt, &c. River, Prax. Med, lib. xvi, cap. 1. 



Appearances on Dissection, 255 

esse ; the membranes either inflamed, or the blood vessels 
turgid to an extraordinary degree, give an appearance of 
commencing gangrene, rather than of inflammation, proper- 
ly so called; water was sometimes found in the ventricles, 
with evident effusions into the interstices ; but was an effect 
not general, nor even frequent. " The liver and lungs," 
says he, ' ; are sometimes, as it were, suffocated and oppress- 
ed j the lungs are like a bag filled with grumous blood, the 
liver and spleen distended with black blood, in such a man- 
ner that the coverings are sometimes ruptured,* 

Dr. Mackittrick, in his inaugural dissertation upon the 
yellow fever of the West Indies, says that in some of the pa- 
tients who died of it, he found the liver spleacelated, the gall 
bladder full of black bile, and the veins turgid with black 
fluid blood.t 

Dr. Broag, who performed many dissections in yellow fe- 
ver, and in the dysentery of hot climates, observes, that the 
liver was almost always found diseased. 

By way of further and collateral illustration of this sub- 
ject, I will here subjoin a few observations on the appear- 
ances on dissection in other forms of malignant fever, as 
well as in the yellow fever itself. For some of these obser- 
vations, T am much indebted to Vol. XV. Part 1, of Dr* 
Recs' New Cyclopedia. 

Dr. Paloni, in his account of the yellow fever of Leg- 
horn, informs us, that the lungs were gorged with blood, so 
that when cut they resembled liver. The stomach was 
gangrenous, especially its internal coat ; was filled with black 
matter similar to that vomited, and had its whole vascular 
system turgid with blood. The intestines were mortified 
throughout their whole length; and the small ones, in par- 
ticular, were filled with mephitic vapor. The kidneys man- 
ifested symptoms of inflammation, and the urinary bladder 
was empty and marked with gangrenous streaks. 

It is stated by Sir John Pringle, that when the jail fever 
proved fatal it terminated in actual mortification of some 
part, that the intestines; in particular, were apt to mortify, 
and that abscesses were found in the brain. In the nume- 
rous dissections of those who died of the plague at Mar- 
seilles, and of the malignant hver at Rouen, some of the 
viscera were alwavs found in an inflamed and gangrcnou? 
state.! 



* Jackson on Fever, 
t Rush's h*q. &; Obs. Vol. III. p. 170. 

| Traite de la Peste, part 1. Le Cats' Act. of the Mali?-, lev at Rouen 
Phil. Trans. Vol. 49, part 1. Hoffman de Feb, 



25G Appearances on Dissection. 

In the account of an epidemic fever which occurred at 
Genoa, in the year 1805, published by two physicians, it 
is stated by both that congestion of blood was found in the 
brain, but in other cases the brain was in a natural state. 
And a Dr. Ek-field, who published an account of an acute 
typhus, as it prevailed at Leipsic, in 1 799, observes, " in 
very careful dissections of tire brain, though I only once de- 
tected an abscess, and this was in the right hemisphere, 
about half an inch in diameter, the vessels, particular those 
in the vascular membranes, almost always appeared turgid 
with blood. The four ventricles abounded with water, and 
sometimes a good deal of extravasated blood was present. — 
The cortical substance was inflamed,' soft, and flaccid."* 
It was observed by Chambon,t that the substance of the 
brain, in every part, is often found harder than natural after 
malignant fever. This, Dr. Clutterbuck remarks, we know 
to be a common efiecjfc of inflammation in other parts. I In 
an answer to this opinion of Dr. Clutterbuck, that the proxi- 
mate cause of fever is seated in the brain, the writer in 
Rees' Cyclopedia judiciously remarks, that not only, are 
these congestions and inflammatory phenomena of the brain 
frequently absent, but sometimes together with them, and 
not seldom in their absence, similar appearances are ob- 
served in other viscera, more especially in those of the ab- 
domen. Dr. Munro included other organs with the brain, 
in his mention of the morbid changes produced by fever; 
and Dr. Pringle remarks, that when contagious fevers prove 
fatal, it generally terminates either in actual mortification of 
some part, or in an abscess of the brain ; and he adds, that 
the intestines, more particularly, are disposed to mortify. 
He likewise quotes the Traite de la Peste, io prove that 
some of the viscera were always mortified and inflamed, the 
brain and lungs most frequently, in those who died of the 
plague at Marseilles. Dr. Eisfield, continuing his descrip- 
tion of the appearances discovered by dissection of those 
who died of the Leipsic fever, says, i; the lungs were often 
found destroyed, inflamed, ulcerated, gangrenous, covered 
with exuded lymph. The liver inflamed, (especially the 
concave surface,) tender, flaccid, full of blood, or pale and 
bloodless. I did meet with inflammation and gangrenes of 
the uterus, the urinary bladder, the prostrate and other 



* Beddoes' Researches, Anatomical and Practical, concerning Fever, as 
connected with Inflammation, p. 48. 
+ Obs. Clim. ?rac. Obs. 29. 
+ Inquiry into the Seat and Nature of Fever, part 1, p. 173. 



Jippaarances on Dissection. 257 

glands, particularly the mesenteric, of the colon and rec* 
turn." " The pains in the head were sometimes so violent, 
and the delirium so furious, as to indicate inflammation of 
the encephalon, which, however, was discovered in the ab- 
domen." In three dissections of persons cut off by an epi- 
demic fever in Normandy, Dr. Moncet found the vessels of 
the brain and its membranes gorged with dark blood; the 
lungs were also diseased, all the ramifications of the mesen- 
teric arteries full of black coagulated blood ; the intestines 
in part inflamed, in part putrid and gangrenous, in two of 
the cases a prodigious congestion in the small curvature of 
the stomach and in all the intestines, especially the small. — 
Of the fever which raged at Leghorn in the summer of 1 804, 
Thiebauit reports, that there were Hew of the viscera which 
it did not leave sometimes sound, sometimes gangrenous, or 
at least with black spots upon the surface. This alteration 
was especially seen on the concave part of the liver, the in- 
ner surface of the stomach and intestines, often in the right 
side of the lungs and diaphragm : the abdominal viscera* 
and still more the abdominal muscles, were excessively flab- 

| by and tender. The cavities of the thorax and abdomen, 
the pericardium and ventricles of the brain, contained a 

•yellow liquid, often fetid, and of a dark bloody tinge. The 
superficial vessels of the viscera, especially those of the 
brain and intestines, appeared dilated, and their extremities 
filled with black matter. " Nothing was found constant but 
the gangrenous nature of the alterations, and their being 
more concentrated on the stomach and intestines than in the 
other viscera. Palloni* gives a very similar account. In 
his dissections, the force of the disease still more plainly ap- 
pears to have been exerted upon the abdominal and con- 
tiguous viscera. During a similar epidemic in 1800 in Spain, 
Professor Sabater and Ramos found in the abdominal vis- 
cera saneous and purulent effusions, with gangrene. It is 
expressly said, that in two other great cavities, the head and 
the thorax, essential changes were seldom found. In some 
subjects, however, black gangrenous points appeared upon 
the lungs, and in others upon the brain. The alterations 
in the abdomen were the only ones that can be considered 
as the direct and immediate product of the disease. Dr, 
Ffrith, house surgeon to the Philadelphia Dispensary, in- 
forms us, in his dissertation on malignant fever, (1804,) that 
the brain was generally found in a diseased state, the menin- 
ges being considerably inflamed, the dura mater being some^ 

* Ob?er. Med. Livorno, 1804. 

a a 



£58 Appearances on Dissection. 

times agglutinated to the pia mater, the blood vessels turgid 
with blood as if injected, the brain firmer than usual, water 
frequently in the ventricles, and sometimes blood effused 
between the meninges. The stomach was always diseased ; 
great inflammation observable throughout ; erosions of the 
villous coat frequent; inflammation extending to the intes- 
tines; bladder diseased; liver, spleen, pancreas, kidneys 
generally sound : lungs, pericardium and heart inflamed. — 
The writer in Rees' Cyclopedia adds, that "in two cases 
we lately investigated by dissection, the villous coat of the 
small intestines was ulcerated in parts, and altogether de- 
stroyed in others; the brain, at the same time, bore marks 
of great congestion in one case, and its ventricles were much 
distended with serum in another.* 

* See Rees' New Cyclopedia, Vol. XV. Part 1. 



It may not be out of place, nor uninteresting, to point out a few of the* 
circumstances of analogy between the operation and effects of morbid and 
other poisons, as those of the animal and vegetable kingdoms. 

Dr. Cooper found in an animal destroyed by stramonium, (Jamestown 
weed,) two drachms of water in the ventricles of the brain; and dissolved 
blood appeared in the biood vessels, and dark coloured bile in the intestines 
and gall bladder. In two persons who used the boiled leaves in New-Jer- 
sey, violent diseases supervened ; mania in one, arid tetanus in another. — 
{Barton's Lectures on Mater. Med. as quoted by Cooper. Cald. Col. Thts.) 
Two children who had eaten of the seeds, seemed to labor under hydro- 
phobia, according to Dr. Lobstein. (Ibid) According to the experiments, 
and observation of Dr. Patrick Russel, made in Hindostan, a general stu- 
por and disposition to sleep, were induced in several instances when the bite 
of the Cobra de Capello was accidentally indicted on the human body. — 
(Dune An. of Med. Vol. II. p. 13.) " I have it from respectable author- 
ity," says Dr. Pascalis, " that the bite of a certain venomous snake in Mar- 
tinico has been known to be attended with considerable jaundice.— (Cox^s 
Phil. Med. Mus. Vol. III.) Convulsions were produced in animals by the 
poison of the viper and other poisons inserted into wounds, according to 
Fontana. — (Fontana on Poisons, Vol. f.) "The symptoms which follow 
on the bite of a viper," says Dr. Mead, " are great faintness, and a quick, 
though low, and sometimes interrupted pulse, great sickness at the stomach, 
with bilious convulsive vomitings, cold sweats, and sometimes pains about 
the navel ; the colour of the whole skin, in less than afc hour, is changed 
yellow, ns if the patient had the jaundice.— (Mead's Works, p. 21. On Poi- 
sons. Of the Viper ) 

The Indians in South America, who hunt with arrows poisoned with the 
ticunas, eat, with impunity, the flesh ot animals thus taken. 

Fontana found that the space of time that elapses before the venom of the 
viper gives manifest tokens ofthe disease it produces, is from fifteen to twen- 
ty second-, or thereabout? — (Fontana on Poisons, Vol. I. p. 297.) It was 
observed by the same author, that by injecting the venom of a airier into 
the jugular vein, the blood was i» most instances coagulated, though some- 



Prevention of Fever* 25B, 



CHAPTER XIII. 



OF THE PREVENTION OF FEVER. 

It is evident that the prevention of fever must be founded 
iipon the knowledge of its remote causes, and the means of 
counteracting or removing them. 

We have seen that the remote causes are, principally, nox- 
ious exhalations from putrefying animal and vegetable mat- 
ters. In many instances it is not in our power to remove or 
remedy these evils, particularly when they are widely and 
generally spread over an extensive country. But when they 
are more limited and local, much may be done by human 
means and industry. Marshes may be drained, ponds ditch- 
ed or filled with earth, stagnation of water guarded against, 
inundations prevented, &c. 

The preventive remedies of fever naturally divide them* 
selves into personal and local. 

time3 fluid, and of a black colour, and that extravasated black blood was 
seen in various parts of the body ; in the heart, lungs, intestines, adepose 
membrane, &c. — (Ibid, Vol. I. p. 359.) 

The production of jaundice, convulsions, vomiting, and painful and spas- 
modic retraction about the navel, are the common consequences of the ope- 
ration of all poisons. 

It was observed by Fontana, that in animals, the parts that have been bit 
by a viper pass in a short time to the strongest putrefaction, and present 
gangrenes and sphacelation. The skin is suddenly corroded and destroy- 
ed ; the muscles are black and foetid ; and the adepose membrane dissolved. 
" I have known," says he, " a rabbit die in less than three hours, with the 
muscles of the leg already gangrened throughout their whole substance ; 
they were black and offensive, and were divided with a knife without any 
resistance. In a word this putrefactive tendency of the muscles, in animals 
that have been bit by the viper, cannot be denied, and is occasioned by the 
change wrought in the blood by the venom." — (Ibid, p. 403.) 

The poisons of the viper and of the ticunas, prevent the blood with which 
it is mixed, from coagulating, and turn it of a dark black colour - Fonta- 
na on Poison, Vol. II. p. 125. According to the experiments of Dr. Larj- 
grish, laurel water possesses the same property of producing a dissolution in 
the crasis of the blood. And the bite of the Lybian serpent, the haemorrhois, 
possesses this quality in so remarkable a degree as to cause the blood to ex- 
ude from every pore in the body. 

Fontana found the lungs of animals destroyed by the poison of the ticunas 
more or less spotted ; the spots being frequently very large and livid, and 
sometimes the part seemed quite putrid. — (Fontana, Vol. II. p. 126.) 

There is a peculiarity in the cherry laurel, inasmuch as the water of this 
poison does not kill when injected into the veins, or applied to wounds; but 
suddenly when taken into the stomach. — (Ibid.) 



260 Prevention oj Fever* 

SECTION I. 

Of Personal Remedies as Prevtntives of Endemic Fever. 

In my treatise on scurvy, I have there pointed out the 
agency of animal food as one of the principal causes in the 
production of that disease : from the analogy of fever and 
scurvy, as well as from experience, the same observations 
are applicable here. The general experience of phy*icians 
confirms the utility and importance of abstinence from ani- 
mal food in hot climates and unhealthy places. When (he 
theory of acidity in the fluids, as the proximate cause of cer- 
tain kinds of fevers and fluxes prevailed among physicians, 
fruits of every description were considered as injurious to 
the healthy and the sick; to the former, as favoring the at- 
tack of disease; and to the latter, as aggravating its symp- 
toms: and thus the most salutary antidotes were avoided, 
and considered as only affording a tantalizing temptation to 
the longing appetite in the luxurious abundance of purple 
clusters and forbidden fruits. But these unfounded and er- 
roneous notions are giving place to more rational and juster 
conceptions. Who that will but for a moment consider the 
wise economy of nature, will not observe the most salutary 
provision for man's health and enjoyment ; and every where 
find that wherever the bane of human life exists, there also 
the antidote is afforded ? Thus in cold northern climates, 
where the shortness of the summer scarcely causes ferment- 
ation in animal and vegetable matters, and where the low 
degree of temperature does not admit of the deleterious ev- 
olution of noxious miasmata, we there find that the inhabi- 
tants are almost entirely exempt from the diseases which 
owe their origin to noxious exhalations. Hence the preserv- 
atives of health, which become necessary in hot and tropical 
latitudes, are there conveniently dispensed with. In those 
frigid regions, the human body can scarcely be too highly 
animalized by nutritious viands; there also, instead of the 
acescent fruits, the oily nut furnishes them with a rich des- 
sert. In cold and northern climates, it becomes necessary 
that the blood should be enriched during the inclement sea- 
son of winter by the liberal use of animal food, which, by 
affording a large proportion of red globules and gluten, thick- 
ens the vital fluid, raises the temperature of the body, and 
enables it to resist more effectually the front and cold by 
which it is assailed. 



Prevention of Fevev* Q&i 

A9 we advance from the temperate zones towards the 
poles, we find that the quantity and proportion of fruits, 
herbs, and vegetable growth of every description, gradually 
diminish; until, at length, we arrive at a region of perfect 
sterility and eternal desolation : no verd&nt hills and flowery 
vales meet the exploring eye, nor within the circle of an 
extended horizon does any thing present itself but a dreary 
melancholy waste : mountains of snow and ice rear their 
frozen summits from the vales, and chill the air with the 
benumbing breath of everlasting winter; yet even here, 
upon these outskirts of the earth, we find that man has fixed 
his habitation ; here he cherishes the social virtues and the 
kindred sympathies which unite him in the bonds of affec- 
tion to his wife, his kindred, his children and his friends ; 
here he finds a home, which he would not exchange for all 
the luxuries of the Indies, or the wealth of kingdoms. Suf- 
ficient, as a garment, for the simple Greenlander, is the 
furry covering which warmed the bear; whilst the train oil 
of the whale affords him a most delicious banquet. 

But, to return from this digression, my object was to show 
that the increasing salubrity of climates, as we advance to- 
wards the poles, compensates for the decrease of vegetable 
food ; so that in the cold and barren regions of the north, 
the inhabitants may generally subsist with safety almost ex- 
clusively upon the flesh of animals.' In a former work,* 
however, I have shown that to this there are certain excep- 
tions ; and that although the natives of these northern cli- 
mates are free from the endemic fevers of the south, yet 
that their gross diet of animal food has sometimes given rise 
to scurvy and scorbutic disorders of a very malignant and 
fatal character. 

In warm climates, where miasmatic exhalations are 
greater, we find a more liberal provision of fruits and vege- 
tables to counteract their pernicious tendency. As we ap- 
proach the equator, we still observe this wise provision and 
economy of nature, keeping pace with the demands and 
necessity of mankind ; and in the tropical latitudes, where 
fever puts on a malignant aspect, and reigns throughout the 
year, we find the most prodigal abundance of those sove- 
reign antidotes. Here man's health is consulted, and his 
appetite gratified with the banana, the milk and fruit of the 
lactiferous palm, the fig, the pine apple, the orange, the 
liime, the lemon, &c. 



* F 



See Observations on Scurvy. Topography and Diseases of Louisiana. 



262 Prevention of Fever. 

In more temperate climates, we find that the fruits begin 
to ripen at that season of the year in which they are most 
required: that is, in the latter part of summer, and in au- 
tumn, when the causes of sickness prevail, and disease 
makes its appearance. During the earlier part of the sea- 
son, the unhealthy products of decaying animal and vege- 
table matter had been prevented from contaminating the 
atmosphere in any considerable degree, by the rapid growth 
of vegetation, which appropriated to its nourishment and 
increase the otherwise deleterious products of putrefac- 
tion,- but towards the close of summer, vegetation is less 
rapid, and comes nearly to a stand ; as vicarious of this 
salutary process, however, nature presents us with the deli- 
cious fruits of the season ; which, being of an acid and aces- 
cent quality, serve to prevent, decompose, and carry off re- 
dundancy of bile, and to sweeten and purify the blood. 

Such are the wise provision and economy of nature, di- 
rected by an overruling Providence to minister to our ben- 
efit and welfare : nor can there be a doubt, that in propor- 
tion to the prevalence of the causes of endemic fever, does 
the exclusive use of fruits and vegetables become the more 
necessary ;. so that during the summer season, in hot and 
unhealthy climates, these articles, to the exclusion of ani- 
mal food, should constitute the diet of the inhabitants. 

The same effects are found to take place from the opera- 
tion of noxious miasmata, as from the use of animal food 
and spirituous liquors : that is, they all have a tendency to 
increase the alkaline state of the fluids, and consequently, 
to occasion an undue secretion of bile ; and we accordingly 
fed that fruits and vegetables are no less necessary in the 
prevention of fever, than in the cure of scurvy. 

What would be the effects of substituting animal in the 
place of vegetable food, in unhealthy climates during the 
summer season ? Why, agreeably to my experience, as well 
as that of every other physician who has made any observa- 
tion under such circumstances, fevers and fluxes would be 
the inevitable consequences. I have uniformly found this 
to be the case in ail parts of the southern portion of the 
United States, wherever it has been my fortune to have 
charge of the health of troops stationed at any particular 
post. This was strikingly exemplified in East Florida, in 
the year 1818, during, and subsequent to the campaign 
against the Seminole Indians. At that time it was impossi- 
ble to procure fresh vegetables. The country was an un- 
inhabited wilderness, and the troops were obliged to subsist 
for a considerable time, entirely upon pork and bread : and 



Prevention of fever* 263 

in a country where so much warmth and humidity prevails, 
it will readily be supposed that these articles were in an 
unbound and partially spoiled condition; which state was 
still father increased by the exposure to which the provis- 
ions themselves were subject, from the want of store houses 
and shelters. The sickness was, consequently, unusually 
great among the soldiers. 

We observe in nature, a propriety and order which can- 
not be sufficiently admired. In the summer season, we be- 
Hold the branches loaded with refreshing and salutary fruits, 
and the prolific vine bending in luxuriant festoons with ifs 
purple clusters. As the season advances, and the causes 
of disease diminish, this profusion gradually declines 5 
enough, however, still remains for the necessities of man: 
adapted to the season, and in succession to the acescent 
fry its, the oleaginous nuts are offered to our acceptance. 

It would scarcely be supposed that the instructions of 
science and philosophy were required to teach mankind 
such plain and palpable precepts and demonstrations of na- 
ture. Instinct, herself, would direct them to the use of 
means and provisions so grateful and congenial to their ap- 
petites, and so conducive and salutary to their health and 
comfort ; but man's blind and erring reason diverts him from 
the path of safety, and there enjoins caution and forbearance 
where nature cries indulge. 

It is not so much from the heating and stimulating opera- 
tion of animal food, that its use proves injurious in hot and 
tropical climates; but its hurtful operation is to be attribu- 
ted to its producing an unhealthy condition of the fluids, al- 
ready too highly animalized* by miasmatic matters blended 
with them. That such an unhealthy condition of the fluids 
does take place, the experience of every person who has 
resided for any considerable time in unhealthy climates must 
abundantly confirm : he has there, undoubtedly, experien- 
ced an undue secretion of bile, and found the necessity of 
an occasional cathartic or emetic to carry off this hurtful 
redundancy. It is to counteract this disposition of the fluids 
of the body that fruits and vegetables are so absolutely ne- 
cessary during the summer and autumnal seasons. 

It is owing to their temperance and to their light acescent 
diet that the Brahmins in India, the natives of the Canary 
Islands, Brazil, &c. who subsist almost entirely on fruits, 
herbage, grains and roots, live so exempt from disease. It 

* By animalized, vm.y be understood that condition of animal bodies which 
constitutes a chemical difference between them and vegetable substances. 



264 Prevention of Fevek 

is true the religion of the Brahmins prohibits the use of anir 
mal food; but the wisdom and utility of their religion, in 
this respect, is founded on nature and experience. 

"A man of vigorous constitution," says Tissot, "lives 
healthy and strong upon bread, water and milk, to one hun- 
dred and tifiy, while those who study nothing else every day 
but new varieties of food, hardly reach the age of fifty, with 
frequent sickness too." 

The advice of Solomon, that oracle of wisdom, is worthy 
of being remembered : " Be not greedy in thy banquets," 
says he, "and give not thyself over to meat; for in much 
meat there is sickness. Many have died through fulness, 
but he that is temperate lengtheneth his life." 

It may be contended that animal food is necessary to sup- 
port the strength of the body under the oppressive and ex- 
hausting influence of the summer heat; but how happens it 
that the negroes in the West Indies, and on many plantations 
in the southern states, are able to work sixteen hours out of 
the twenty-four, and never taste a mouthful of flesh through- 
out the year ? It is to this want of animal food that their ex* 
emption from disease, notwithstanding their fatigues and 
exposure, in a great measure is to be ascribed.* 

We are informed by Mr. Verdom, that the Greek chris- 
tians in Smyrna, during the season of Lent, when they eat 
only vegetables, are very seldom attacked by the plague, 
whilst among those who eat flesh the disease makes great 
havoc. 

It is remarked by Aurivilius, that those who live on pork 
and fish are more subject to fever than others. 

Dr. John Sherwan, in his observations on the bilious dis- 
eases of Bengal, speaking of the mortality among the Euro- 
peans, and contrasting it with the health of the natives, 
makes the following pertinent reflections. " Let us," says 
he, "take a view of the customs of the original natives. 
They eat little or no animal food; they drink water, or 

* " A vegetable diet," says Dr. Falconer, "by keeping the passions with- 
in due bounds, is a remarkable preservative of purity of morals. 

" Whilst the people of the East, in general, are immersed in debauchery, 
profligacy, and all kinds of wickedness, the natives of India are regular in 
their conduct, and just and merciful in thfir dealings. 

" A diet of this kind is, in the main, very favorable to the mental fac- 
ulties. 

" The great degree of boddy strength, and consequently tense fibre, pro- 
duced by animal food, is also inconsistent with that delicacy of sensation, 
which is the parent of liveliness of imagination, quickness of apprehension, 
and acuteness of judgment." — Falconer on the Influence of Climates, Ctfs*- 
foms, &c. 



Prevention of Fever, 26d 

aqueous fermented liquors with the juices of fruits or plants, 
and milk; and thej live almost entirely free from bilious 
disorders : yet they breathe the same noxious effluvia that 
we do, and are much more exposed to the heat of the sun." 
And that this difference is not entirely owing to the circum- 
stance of the natives being accustomed to the climate? he 
says, " Every one must have observed, that the black people 
who have adopted the language of the Portuguese, and who 
indulge in the luxuries of the Europeans, are not exempt 
from bilious or putrid disorders."* 

The exemption of negroes in sugar colonies from diseases 
which rage among the whites, and even among the domestic 
slaves, is justly attributed by Wilson, in his Essay on Cli- 
mate, to the vegetable diet on which those unprivileged la- 
borers subsist. 

Many lives have been lost to the public service in conse- 
quence of soldiers being obliged to subsist upon too great 
a proportion of animal food. It is contended that in pro- 
visioning an army it is necessary for the convenience of 
transportation, to select such articles as contain the greatest 
quantity of nourishment in a given bulk. If, however, the 
strength of an army depends upon the health and soundness 
of the troops, it will doubtless be granted, that for the pur- 
pose of securing these advantages, some sacrifice should be 
made on the part of convenience. From what has already 
been said, it will clearly appear that a deficiency of vegeta- 
ble food will be more severely felt in hot, than in cold and 
temperate climates. A diet that might be comparatively 
healthy on the northern frontier, would prove highly perni- 
cious on the southern. This was strikingly exemplified in 
the fatal epidemic and scurvy of Terre aux Bceufs, in the 
year 1809.1 

Dr. Rush, upon this subject, has made some judicious 
observations. " The diet of a soldier," says the Doctor, 
"should consist chiefly of vegetables. The nature of their 
(his) duty, as well as their (his) former habits of life, require 
it. If every tree in (on) the continent of America produced 
Jesuit's bark, it would not be sufficient to restore the health 
of soldiers who eat one or two pounds of flesh in a day."| 



* Duncan's Annals of Medicine, Vol. VI. p. 475. The great fatality 
which at one time attended the 6mall pox, was at last prevented by the ex- 
clusive use of a vegetable diet. 

t For an account of this disease, see Observ. on the Topog. & Diseases of 
Louisiana. 

if; Rush's Directions for preserving the Health of Soldiers. Addressed to 
the Oilicers of the Army of the United State*. 

i 9 



266 Prevention of Fever. 

In illustration of the pernicious effects of the inordinate 
use of animal food, it was observed by Dr. Huxham, that 
" the Spanish and French prisoners, by eating unusual and 
immoderate quantities of flesh, brought on such dangerous 
fevers as carried off vast numbers of them ; they were so 
fond of it, that they frequently died, as it were with flesh in 
their mouths."* 

Dr. Jackson remarks,! that the French and Spaniards eat 
less animal food, and drink their liquors greatly more dilu- 
ted, than the natives of England, and that their greater ex- 
emption from disease bears some proportion to the degree 
of abstemiousness observed. 

Dr. Lind, speaking of the diseases incidental to Europe- 
ans in hot climates, observes, " It is, indeed, a truth con- 
firmed by most fatal experience, that their devouring large 
quantities of flesh meats, and using the same heavy obdu- 
rate food in the West Indies, or upon the coast of Guinea, 
and in other warm countries as they were accustomed to at 
home, have proved the destruction of many thousand Eng- 
lish in those climates. J 

It is stated by Dr. Nassy, in his History of Surrinam, that 
the Jews of that country who subsist principally upon fruits 
and vegetables, and use a considerable quantity of pepper 
and spices in their food, escape the bilious fevers ; whilst 
the christians, who indulge in their European luxuries and 
viands, perish in great numbers. 

One effect of heat is to diminish the appetite, in conse- 
quence of the lessened vigor of the digestive organs. A na- 
tive of the northern states migrating to the south, is at first 
astonished at his own voracity when compared with the 
moderation and abstemiousness of the southern natives. — 
His appetite, however, as well as his constitution, becomes 
acclimated in a great degree to his adopted country, and he 
finds that he is satisfied with a much smaller quantity of food 
than when he inhabited his native region of the north. Per- 
sons residing in the same climate had that a long continu- 
ance of heat during the summer, impairs their appetites and 
diminishes their relish for solid food. The inhabitants of 
the West India islands, at the time of their discovery by 
Columbus, were astonished and alarmed at what they con- 
sidered the excessive gluttony of the Spaniards ; one of 
whom devoured in a day, nearly as much as would have 



* Huxham on Fever, p. 56. 
t Diseases of Jamaica, p. 161. 
t Diseases of Hot Climates, p, 23, 



Prevention of Fever* J^Sf 

been consumed by a native, in a week. It is remarked by 
Baglivi, that the inhabitants of Rome eat very little, and that 
their food consists principally of vegetables. He further 
observes, that strangers who go there, by degrees lose their 
appetites. Nature, though at war with man, is seldom wrong 
in her indications, as far as it regards that which concerns 
his health and comfort; and this lessened appetite, produ- 
ced by heat, is his best security from the diseases which this 
increased temperature is apt to occasion. 

The use, or abuse of spirituous liquors, is an improvement 
of the moderns, which so far from remedying the inconven- 
iences and hardships of a military life, is but adding to the 
evils which are almost inseparably connected with it. — > 
When the Romans made war in hot countries, their com- 
mon drink was vinegar mixed with water, which they called 
posca* But with our army it is a matter of indifference 
whether they are exposed to the winter's cold of the Canada 
frontier, or to the summer's heat of Florida, spirituous li- 
quors are in every situation equally indipensable. 

To this it may be answered, that if the free indulgence 
of spirituous liquors is so injurious, how comes it that ha- 
bitual drunkards, and persons who keep themselves con- 
stantly under the influence of ardent spirits, frequently es- 
cape the endemic fevers of unhealthy seasons and situations? 
To this I would reply, that intoxication, or the operation of 
spirituous liquors, produces, for the time, an insensibility 
to other impressions ; but that unless this excitement is kept 
up with tolerable uniformity, the bod}- is rendered more lia- 
ble to be attacked during the period of atony and relaxation 
which follows the state of previous excitement; and it has 
been found that whenever persons of this description become 
the subjects of fever, it is very apt to prove fatal, or to as- 
sume an aspect of unusual malignancy. It was observed by 
Dr. Rush, that most of those who were alternately drunk 
and sober, died of the yellow fever. I had also occasion to 
remark this in a public hospital, where a man was selected 
to do the washing for the sick; from the fatigue and labor 
of his duty he was allowed, each day, an extra gill of whis- 
key, so that with this, together with that which he received 
from the charitable contribution of his friends and from other 
means, he was enabled to keep pretty uniformly in a state 
of intoxication, or in other words, comfortably drunk. His 
services, however, were not o* long duration ; he took the 
fever and died. A second, a third, and a fourth, who seve- 

* Nonius De re Cibaria, lib, iv. cap. 15, p. 179, 



268 Prevention of Fever, 

rally succeeded each other in the capacity of washers, and 
who followed the example of their predecessors, shared the 
same fate, in the course of one season.* Whatever part of 
this misfortune was to be ascribed to contagion, the pre- 
sumption is, that the principal mischief arose from intoxi- 
cation. 

It is scarcely necessary to observe, that water is the most 
wholesome drink that can be used during the summer sea- 
son ; its virtues, however, may be improved by the -addition 
of vegetable acids. It was to the exclusive use of water as 
a beverage, that the great Dr. Haller owed the entire pre- 
servation of all his senses, and particularly of his sight, to a 
very advanced period of his life. 

In the prosecution of the inquiry, the next subject that 
claims our attention as preventives, is the use of such reme- 
dies as evacuate morbified matter from the system, as is- 
sues, emetics, cathartics, &c. 

The utility of issues in the prevention of fever in individ- 
uals, is a doctrine as old as the days of Hippocrates ; besides 
whom we may mention among the advocates of this remedy, 
Pareus, Zacutus, Platens, Galen, Lusitanus, Diemerbroeck, 
Fabricius, Lancissi, Hildanus, Senertus, Willis. Muller. Mer- 
culialis, Liutaud, Prosper Alpinus, Koempfer, &c. We are 
informed by Procopius, that during the prevalence of a de- 
structive plague, those who had ulcers on any part of the 
body generally escaped the disease. It is said by Plateus, 
that in the plague which prevailed in Leyden in 1564, all 
who had issues remained uninfected. He gives an account 
of a certain monk, who went about establishing issues in 
persons as a preventive of the disorder, and who brought on 
a suppuration by introducing a piece of black hcljebore into 
a wound made in the scrolum ; and which, on account of its 
efficacy, was considered as a charm. 



* Dr Lind and Dr Trotter ascribe the danger of washing for hospitals to 
infection or contagion, from the foul clothing. Dr. Lind observes, that the 
nurses of hospitals know well that there is most danger of catching iever^ 
■when they pile heaps of bed clothes or body linen together, for a few days, 
before it is carried to the wash-house. " The washer women at Haslar, - " 
says Dr. Trotter, " have told me that they know when any dangerous fever 
is in the hospital, from the bad smell of the clothes ; this makes them air 
them abroad, till the smell is gone, and then they can wash them with safe- 
ty. But if it happened from the hurry, that this could not be done, or if it 
was neglected by design, many of them have been seized with the sickness. 
The porters and people employed in cleaning and fumigating the blankets 
and beds at Haslar, are well acquainted with this fact, and they measure 
the danger by the badness of the smell." Trot. Mtd. JS r aut. Vol I.j>. 178. 



Prevention of Fever. 269 

Volney informs us, that the monks of Man Hannah El 
Chonair, in Syria, were much less affected with the disease 
of the country, than the peasantry amongst whom they lived : 
and they attributed this superior degree of health to an issue 
which they constantly kept running in one of their arms. 

It is said by Dr. Jackson, in his account of the diseases 
which prevailed among the English troops in St. Domingo, 
that the healing of an ulcer was often followed by a fatal flux 
or a dangerous fever. " It is observed/' says this author, 
"that persons subject to diarrhoea, from slight causes, gene- 
rally escape serious attacks of fever. This seems to point 
out the propriety of opening the body freely by purgatives ; 
as the knowledge of the fact, that ulcers of the legs and fe- 
ver do not often exist in the same subject, seems to indicate 
that to open issues might be a means of preserving health." 
Baron Larrey found that none of those whose wounds were 
in a state of suppuration became affected with the plague. 
He also states, that the Europeans who are established in 
Egypt, and in Syria, preserve themselves from the plague, 
or, at least, suffer but little from it, by keeping setons or ar- 
tificial drains constantly discharging. 

The use of emetics and cathartics comes now to be consid- 
ered as preventives of endemic fever. 

There can be very little doubt that in cases of suppressed 
perspiration much of the excrementitious and morbific mat- 
ters retained is determined to and carried off by the bowels. 
This appears from the sympathy established between them 
and the surface of the body. A copious and free perspira- 
tion relieves or puts a stop to a diarrhoea, and the latter is 
apt to take place from a check given to the perspiration. — ■ 
We know that excrementitious fluids are often determined 
from their proper emunctories, and solicited to some vica- 
rious outlet. We know especially that the bile is liable to 
great alterations, both in quality and quantity, as has been 
already pointed out- and as the bowels are the only natu- 
ral channel by which this can be eliminated from the sys- 
tem, the necessity of effecting its expulsion in this way, be- 
comes evident in all cases of redundancy of this fluid. — - 
Though the proximate cause of fever does not consist in the 
quantity of biliarj secretion, yet as the bile itself, under such 
circumstances, contains a considerable share of morbid poi- 
son, and by its accumulation would be disposed to increase 
the diseased condition of the circulating fluids, it is highly 
necessary that such accumulation should be prevented by 
the use of an emetic or cathartic upon occasion of any threat- 
ening symptoms of ill health. If the symptoms of fever have 



270 Prevention of Fever, 

not fully established themselves, a brisk cathartic will often- 
be found sufficient to prevent the formation of disease. But 
if the indisposition be greater, an emetic should precede the 
cathartic. As an emetic, I commonly employ the tartarized 
antimony; dissolving about ten grains in half a pint of warm 
water, of which the patient (always supposing an adult) is 
directed to drink off about one third, and should that not 
operate sufficiently in fifteen or twenty minutes, a table 
spoonfull is to be repeated every ten or fifteen minutes till 
it has operated four or five times. In females and persons 
of delicate constitutions, white vitriol or ipecacuanha, or 
both combined, should be given in preference to the tartar- 
ized antimony. 

Independent of any disagreeable feelings and premonito- 
ry symptoms of disease, the occasional use of cathartics iu 
warm climates and unhealthy seasons will be found highly 
advantageous. As answering the place of more active med- 
icine, I have been in the habit of prescribing the tincture of 
aloes and rhubarb, to which may be added some aromatics. 
This tincture taken every morning before breakfast, in such 
quantity as to produce one or two free evacuations in the 
course of twenty-four hours, I have found of singular benefit 
as a preventive during the summer season. Its preventive 
pow r ers may be stiil further increased by the addition of a 
tea spoonful of Peruvian bark to each dose. Cream of tar- 
tar beverage, as answering the same purpose, is also an ex- 
cellent remedy during the summer season. A citizen of Phi- 
ladelphia asked the captain of a New-England ship, whom 
he met in Batavia, how he preserved the whole crew of his 
ship in health, while half the sailors of the other ships in the 
harbor were sick or dead ? He informed him, that it was by 
giving each of them a gentle purge of sulphur every day.* 

Those remedies and means which promote perspiration 
are also worthy of consideration. When we reflect upon 
the importance of the perspiration in the animal economy, 
it will readily be supposed that disorder must ensue from 
even a temporary suspension of this salutary evacuation. — ■ 
The largest portion of the substances we consume, both as 
food and drink, is carried off by perspiration. But it is in 
summer, more especially, that the consequences of a sup- 
pression of the perspiration are to be apprehended. That 
which during the winter season would merely occasion a 
common cold, in which nothing more than the ordinary mat- 
ter of perspiration would be retained, in the sickly months 

* Rush's Inq. and Obs. Vol. IV. p. 193. 



Prevention of Fever*. 271 

of summer and autumn, would prove the immediate occasion 
or exciting cause of fever. This arises from the circum- 
stances previously mentioned, viz. from the fluids daring 
the summer season, in unhealthy places, being constantly 
impregnated with the matter of fever, and requiring only a 
slight cause to excite it into action. Hence the necessity 
of the perspiration being kept up with constant uniformity. 
The inhabitants of Egypt have such a practical experience 
of the salutary effects of perspiration as a preservative of 
health, that the customary phrase of salutation amongst them 
is, How do you sweat? aware that the suppression of this 
discharge is the sure symptom of approaching disease. A 
free perspiration is one of the surest preservatives of health 
in hot and tropical climates. For this purpose, moderate 
exercise, so as to promote a free flow of perspirable fluid, is 
highly beneficial. It is in this way that persons who are 
employed in regular and constant labor enjoy better health 
and remain more exempt from disease than those who lead 
confined, sedentary, and inactive lives. And I have often 
had occasion to observe, that mechanics, upon resting from 
their employment for two or three days, have been sudden- 
ly attacked with fever. Dr. M'Lean* speaks in high terms 
of the salutary effects of exercise and perspiration; and in- 
forms us, that to a profusion of the perspiration, as the con- 
sequence of active exercise, he attributed his safety, amidst 
so much exhalation of miasmata, for so long a time. " I 
drank freely," says he, "of lemonade, sangaree, tamarind 
water, weak wine and water, and other diluent composi- 
tions ; and when night came on, I was always prepared to 
enjoy my repose." To persons who are not compelled to 
pursue laborious employments, the cool of the day, either 
in the morning or towards sun-set, is the best time for ex- 
ercise ; and convalescents and invalids should avoid expo- 
sure to the sun ; the heat of which is too oppressive and sick- 
ening for their debilitated constitutions. 

For promoting perspiration, the moderate use of onions 
and garlic will be found serviceable during the summer sea- 
son. The great exemption of the French and Spaniards in 
New- Orleans, Louisiana, and other places, from the bilious 
or yellow fever, is to be ascribed, in a great measure, to the 
free use of onions and garlic, their vegetable diet and ab- 
stinence from spirituous liquors. 

* Inquiry into the Nature and Causes of the great Mortality among the 
Troops in St. Domingo, 



272 Prevention of Fever. 

Most vegetables, indeed, possess the property of promo- 
ting the secretion both of urine and perspiration. Many peo- 
ple, particularly those who have derived their notions, by 
hereditary precept, from the antiquated doctrines of the 
medical school, are of opinion that vegetables are injurious 
during the summer, and that the diet, at this season, should 
consist principally of bread and bacon. From what has 
been said, it will readily be perceived that this is reversing 
the natural order of things, and acting in contradiction to 
the plainest indications of nature. In a healthy climate, it 
is not very material on what a person subsists, in case the 
food is not in itself absolutely unwholesome. Corn bread 
and bacon may here be indulged in ad libitum, provided suf- 
ficient exercise is taken, without producing any evil conse- 
quences. Grapes and melons are severely condemned by 
these rigid disciplinarians of the old school. It is true, that 
when, as generally happens after an attack of fever, the 
stomach is left in a debilitated condition, it would be im- 
prudent and hurtful to load it with an overcharge of raw ve- 
getables of any description. Such substances, from being 
difficult of digestion, and from producing irritation in the 
stomach and bowels, would endanger a relapse of the former 
complaint. But it is not altogether the quality of the food 
that should here fall under the ban of reprobation ; it is the 
quantity eaten, and the excess to which the patient has in- 
dulged his appetite. 

When persons, from feelings of indisposition, have reason 
to apprehend an attack of fever, a rigid abstinence, for a 
few days, or till the morbid symptoms disappear, will be 
found of the first importance in the prevention of fever and 
the restoration of health. The food that is used should be 
of the vegetable kind, and just sufficient to support nature 
without feeding the disease. By observing this rule, I have of- 
ten known a threatened attack of fever prevented. u When 
there is reason to fear the approach of bad health," says 
Dr. Fordyce, " the best medicines are rest, abstinence, and 
watery drinks. By such, even violent diseases, when at 
hand, may be dispersed. Abstinence will never disappoint 
us, says Galen." — " In summer," observes Dr. Fordyce, 
"we should eat less, and drink more." {not whiskey or spi- 
rits.) u In autumn, we should avoid fish, and every species 
of food that promotes putrefaction, and live chiefly on fruits 
that will dissolve and carry off the bile."* 



* Fordyce on Putrid Inflam. Fever, p. 89 k 20, 



Prevention of Fever* 273 

Dr. Trotter, speaking of the diseases of unhealthy cli- 
mates, observes, " The use of spirituous liquors in any form 
should be totally laid aside; they are slow poisons in cold 
countries, but here they do the work of destruction quick- 
ly.' 1 * * " Among my own acquaintances who have returned 
in perfect health, I can reckon many, who lived almost on, 
vegetables, and drank water."* 

It was owing to their light and abstemious diet, that 
Socrates in Athens, and Justinian in Constantinople, were 
preserved from the plague with which those cities were af- 
flicted. 

The drinks in warm climates should be those of the cool- 
ing, watery, attenuating kinds ; and as these qualities are 
possessed in an eminent degree by water, we can scarcely 
be at a loss for the most salutary beverage. To render this 
the more pleasant and even wholesome, molasses, vinegar, 
li?ne juice, tamarinds, cream of tartar, or a little wine may 
be added. But that description of hydrophobia, which sub- 
stitutes whiskey and other spirituous liquors for the pure wa- 
ter of the fountain, has caused more deaths by far than ever 
was occasioned by the canine madness. A mad dog is an 
object of general persecution, against whom it is justifiable 
to employ clubs, guns, and missiles of every description: 
but more dangerous and pestilential to the community is a 
drunkard ; an affliction to his family, a scandal to himself, a 
bane and contagion to society, and a disgrace to human na- 
ture. Spruce beer is also a wholesome drink during the 
summer season, and from its acidulous, diaphoretic and diu- 
retic properties, is well calculated to act as an anti-mias- 
matic and preventive of fever. For the same purpose, tar- 
water has likewise been used with considerable advantage 
as a constant drink in unhealthy seasons and situations. 

During the sickly season, the moderate use of tonics will 
be found beneficial as preventives. Of this class, the Peru- 
vian bark may be considered as the most serviceable. Its 
eflicacy in this way is highly extolled by a variety of authors, 
not only as a security against the fever and ague, but also 
against that more aggravated degree of bilious endemic call- 
ed the yellow fever. This remedy is the more necessary 
in persons of debilitated habits, especially in those where a 
predisposition has been established by previous disease. 

It is remarked by Dr. Blane, that men have been some- 
times seized with the fever after they have been at sea more 
than a week : and that as a preventive, nothing is more ad- 

* Medecina Nautica, Vol. I. p. 345. 
K % 



274 Prevention of Fqver, 

visable than to take some doses of bark, after cleansing the 
bowels by a purgative.* Dr. La Fuente used bark for the 
prevention and cure of the yellow fever.t Dr. Lirid con- 
siders the bark as the best preservative from contagious fe- 
vers, and to prevent a relapse, by being early exhibited after 
its recess. i Huxham found the bark and snake root answer 
the same purpose in hospital fever. Mr. Robertson gives 
us a striking instance of the preserving efficacy of the bark, 
in an account of a voyage in the ship Rainbow to the coast 
of Africa. By the use of this remedy, Count Bonneval and 
his suit remained uninfected in the camps in Hungary, whilst 
half the army were destroyed by fever. As a preventive, 
two or three tea-spoonfuls may be taken daily. 

The cold bath will also be found a useful remedy in the 
prevention of fever both in children and adults. By cold 
bathing, is not meant (he idle and unwholesome practice of 
remaining in the water half an hour at a time ; but the tran« 
sient application of this element to the body frequently, as 
well for cleanliness, as for the purpose of imparting tone and 
vigor to the system. The best time for the employment of 
this remedy is in the morning, whilst the circulation is most 
vigorous, and the reaction strongest. 1 should consider my- 
self happy, could I prevail upon that portion of the commu- 
nity whom the romantic fancies of enraptured lovers have 
often exalted to the deified distinction of angelic excellence 
and perfection ; could I prevail upon them to consider clean- 
liness as a moral and religious duty. But alas! how often 
does it happen that a fair exterior, like a whited sepul- 
chre, is but a mockery of the senses, the cloak and covering 
of impurity. They, whose flowing garments are so admira- 
bly constructed to gather to their persons the flying parti- 
cles of the dusty streets, seem frequently to possess the nat- 
ural antipathy of sheep to water. Not so with the French ; 
neat and cleanly in their persons, water is their favorite el- 
ement : and a French lady would as soon think of putting on 
a dirty garment to grace a party, or a ball room, as to ap- 
pear in company or in public with an uncleanly and an un- 
Avashed person. Let our fair-faced citizens imitate their 
wholesome and virtuous example. The experiment will 
delight and surprise them ; it will give them a better opin- 
ion of themselves, and render them more amiable and love- 
ly in the eyes of their companions ; it will preserve their 



* Med. & Phys. Jour. Vol XIV. p. 531. 
T Lind on the Diseases of Seamen, p. 107. 
| Blane on the Dis. of Seamen, p. 231. 



Prevention of PeveK 275 

youth, health, sweetness and complexion, better than all the 
■^osmetics and lotions of the shops, or than all the balms, 
spices, and fragrance of Arabia. Every family in hot cli- 
mates should have a bathing apartment to their dwellings, 
to which they should daily resort for cleanliness and health, 
with as much regularity as the exemplary and pious chris- 
tian to his closet and devotions. 

Many persons are of opinion that wearing flannel next to 
the skin in the summer season, as it promotes perspiration 
and protects against the vicissitudes of the weather, is ser- 
viceable as a preventive of disease. In more northerly and 
colder climates this may apply ; but in the southern states I 
have generally remarked that except in thin, cold, withered, 
and phlegmatic habits, the use of flannel was injurious: in- 
asmuch as it stimulates too highly and produces too profuse 
a perspiration, thereby inducing a hurtful degree of debility 
and relaxation. Cotton shirting, being less heating than 
flannel, and not so apt to give a sudden check to the perspi- 
ration as linen, by transitions from exercise to rest, appears 
to-be better adapted to the southern climate., 

Mercury has by some been considered as a preventive of 
fevers. Its efficacy, however, in this respect, upon careful 
investigation, appears to be very doubtful ; for although it 
possesses the power of evacuating bile, it seems also to favor 
and promote its generation. M. Pugnet, who accompanied 
the French army as physician in Egypt, did not find mercury 
of any benefit as a preventive of the plague. And Dr. Ro- 
bertson, in his View of the Natural History of the Atmos- 
phere and Epidemical Diseases, observes, that he has seen 
soldiers and others fully impregnated with mercury, for the 
cure of lues venerea, attacked with typhus contagion, which 
in every instance seemed thereby to be rendered more se- 
vere.* It was remarked by Dr. Hunter, that mercury had 
no effect upon the constitution to render it less susceptible 
of fever. t " In warm climates," says Dr. Adams, " we see 
the effects of this mineral (mercury) most obviously. If 
exhibited to a constitution whilst there is a crude wound, 
we find it eating as a poison, that is, producing ulceration 
beyond what is necessary for dislodging the dead edges of a 
cut."! 

Dr. James Clark, in his account of the yellow fever of St. 
Domingo, assures us that the officers of His Majesty' 1 s navy 

* Robertson on the Atmosphere, &c. Vol. II. p. 384- 
t Hunter on the Diseases of Jamaica, p. 287* 
J Adams on Morbid Poisons, p. 118, 



276 Prevention of Fever. 

and army, who have leisure and can be prevailed upon (o 
undergo, on their arrival, one or two gentle courses of mer- 
cury, taking after each a few laxative medicines, confining 
themselves to the moderate use of wine, and living chiefly 
on vegetables and fruits, for the two first months, may rely 
almost to a certainty on escaping the fever.* Omitting the 
mercury, no exceptions can be taken to the above advice. 
Fever is sometimes so sudden in its approach as to afford 
but little warning. In many cases, however, it is preceded 
for a day or two, or even for a longer period, by various 
premonitory symptoms, which by a person who has experi- 
enced them are more easily understood than described. — 
The person either loses his appetite or experiences unusual 
voracity ; the stomach and bowels are more or less distend- 
ed and affected with sickness and oppression, costiveness, 
flatulence, and colic. The invalid perceives a bitter taste 
in his mouth, and finds his tongue in the morning covered 
with a whitish or yellowish fur, and sometimes belches a 
mouthful or two of bile from the stomach ; the evacuations 
hy stool are either light, hard and clay coloured, or yellow, 
green or dark, and froth and foam like yeast. The patient 
loses his appetite for solid food, and is disgusted with the 
sight and smell of the viands of the table ; he experiences a 
general sensation of languor and debility, and finds motion 
and exercise fatiguing and unpleasant. The mind is no 
longer capable of close and continued attention to any sub- 
ject of reading or reflection. The eyes are stiff and painful 
in their movements; and pain, languor and fatigue affect 
the larger muscles of the extremities. The invalid experi- 
ences more or less of a head-ache, which is increased on 
motion, or by looking upwards ; his pulse is frequent, small 
and weak, or frequent, full and tense ; the urine is high col- 
oured, and the skin dry and preternaturally warm. He is 
affected with unusual drowsiness, or want of sleep. When 
a person is affected with many or all of these symptoms du- 
ring the prevalence of an endemic fever, he may calculate 
that in the uninterrupted course of the disorder the full de- 
velopement of fever is not far distant; in order, therefore, 
to prevent its formation, he should abstain almost entirely 
from food of every description for a day or two, or till the 
symptoms of indisposition have disappeared. If this should 
not be found sufficient, an emetic or cathartic, or both, be- 
come necessarv. 



* Duncan's An. of Med. Vol. IL p. 169. 



Prevention of Fever, 277 

We are informed that Sydenham cured, or rather pre- 
vented the formation of disease in his children and inti- 
mate friends, in the continued fevers of 1673, 1674, and 
1675, by directing diluents and prohibiting every kind of 
aliment, and in this way making them fast strictly for two 
or three days. 

During the prevalence of an endemic fever, persons can- 
not be too careful in attending to the first admonitions of 
disease. Indisposition, though slight at first, will, if neglect- 
ed, soon terminate in confirmed illness,* painful affections 
of parts which have often been diseased, may be looked up- 
on as ominous, for if there is one part of the system weaker 
than another, the causes of fever will first exert their mor- 
bid influence upon it At such times, what at first was 
nothing more than an intermittent, after a repetition of two 
or three paroxysms will degenerate into a malignant bilious 
remittent. 



SECTION II. 



Of Local Remedies as Preventives of Endemic Fever. 

From what has been observed, when speaking of the 
causes of fever, it will readily occur that vegetation must 
be a powerful means of preventing the deleterious effects of 
the noxious matters evolved during the process of animal 
and vegetable decomposition. This the general experience 
of mankind confirms. And, accordingly, in all parts of the 
United States, at least as far as my information and observa- 
tion extend, it has generally been found that for the first 
year or two after settlements have been made, the country 
remains healthy; until, by the process of clearing, the tim- 
ber and vegetable growth become so much diminished that 
the redundancy of miasmatic exhalations, or in other words, 
the excess of unappropriated decomposing vegetable mat- 
ter, becomes injurious to health and gives rise to disease. — 
This condition of the country continues for one or two years, 
when, from fhe decomposition of the newly turned up ve- 
getable mould, the noxious matters having been diminished, 
and the luxuriant crops of corn and cotton having in some 
degree exhausted the exuberant fertility, disease sensibly 
declines. The mode of clearing in the southern states, also 
favors the effects of decomposition ; the large trees being 
merely killed, and not cut down aud destroyed, are left to 



27b Prevention of Fever*. 

rot and moulder, piece-meal, on the ground. This circum- 
stance, however, bears no proportion to the miasmatic ex- 
halations from the newly turned up soil : for in the western 
part of the state of New York, where the soil is extremely 
fertile, and in other parts of the northern states of like de- 
scription, where they are in the habit of cutting down and 
burning all the timber, and converting it into potash, they 
have been also subject, for the first few years subsequent to 
the clearing, to violent epidemics of bilious or yellow (ever. 

This circumstance, in part at least, has been strikingly 
exemplified in various parts of Alabama, where, in many in- 
stances, the inhabitants for the first two or three years en- 
joyed uninterrupted health ; then again, for two or three 
subsequent years, fevers and fluxes have made their appear- 
ance in the summer season. 

From the known efficacy which the growth of plants pos- 
sesses of preventing the hurtful effects of decomposition in the 
mouldering mass of extinct vegetation, an important lesson 
is presented to our consideration : that in the construction 
of towns in a newly settled country, care should be taken to 
preserve the trees and vegetable growth in its precincts and 
vicinity, except so far as the opening of the streets and the 
erection of buildings may require their removal. Trees 
should also be* planted along the side- walks of the streets, 
at regular and proper distances ; which will possess a three 
fold benefit, as it respects ornament, comfort and health. — 
It is owing to an ignorance of this important fact in the econ- 
omy of nature, that people so far mistake the means of contri- 
buting to their own health and comfort, as to consider it the 
first and most necessary step in the settlement of a town to 
remove every tree and bush from the limits of its enclosure ; 
thus committing wanton havoc and destruction among (he 
preservatives of health, and making an inroad for disease 
and death. Should there beany marshes or low grounds in 
the vicinity of a town, in addition to ditching and draining, 
all the trees by which they arefiiled and surrouuded should 
be suffered to flourish, and their growth should rather be 
encouraged than diminished. The denser the shade and 
the more luxuriant the vegetation in any situation, the less 
will be the danger from unhealthy exhalations. 

Lancissi was not the first who had remarked the salutary 
effects of the planting of forests, and the growth of vegeta- 
tion, in restoring salubrity to the atmosphere. The same 
observation was made by the earlier investigators of physic- 
al science. Changeux, a respectable physician, remarks, 
that the custom is very ancient in ^sia. particularly among 



Prevention of Fever. 279 

flie Persians, who for this purpose cultivate trees, particu* 
larly plantains, both in the environs and in the midst of their 
cities.* 

We are informed by Farquahar, in his account of the cli- 
mate of Jamaica, that in the low lands of that island, par- 
ticularly between Kingston and Spanish-Town, there are 
many swamps and lagoons which form ample sources of dis- 
ease ; the vicinities of these places are, however, more or less 
sickly, as they are or are not clear of wood. In the middle 
of the island, where there are large swampy tracts of land 
covered with high woods, the endemic is seldom known. — - 
As an evidence of this fact, there is a district, known by the 
name of Sandy River, situated in the most remote part of 
the parish of Clarendon, and adjoining St. Ann's, where se- 
veral very productive coffee plantations have been, during 
the last ten years, established, and where, in the space of a 
mile, five or six white families, with several hundred negroes, 
reside; and although contiguous to these plantations there' 
are large tracts of swampy land to (he extent of some miles* 
yet, as they are covered with high woods, and consequently 
sheltered from the action of the sun, both the whites and ne- 
groes in the vicinity, enjoy the most uninterrupted state of 
health.! From which the writer draws the following con- 
clusion, "that for swamps to constitute the source of dis- 
ease, they must be previously acted on by heat. 5 ' The 
reader will perceive, from what has already been said, that 
this explanation is incomplete and defective. 

Lancissi quotes many former writers, in recommendation 
of the salutary effects of woods, when situated between 
marshes, and towns, villas, camps, &c* ; and also gives us 
many striking examples of the deleterious effects from the 
destruction of forests in such situations. 

There can be no doubt that, independent of any othep 
operation and effect which they possess, trees and growing 
vegetables of all kinds have a very considerable influence in 
cooling the atmosphere, not only in their immediate vicin- 
ity, but for some distance around. Every person must have 
been made sensible of this feet, from remarking the change 
of temperature in passing from a town, or place unshaded by- 
trees, to the neighborhood or covert of a wood. The rays of 
the sun, being obstructed by the leaves and branches of the 
trees, their heat is expended, to a considerable degree, among 
the foliage, and is absorbed by the evaporation or vegetable 

* Journal de Physique de i'Abbe Rosier, torn, xxiii. 

t Farquahar's Act. of the Clim. of Jama. Phil. Med. Mus. Vol. I. p. ITT 



280 Prevention of Fever, 

perspiration which is constantly taking place, in hot sunny 
weather, from every leaf that trembles in the breeze. Some 
idea may be formed of the power of evaporation in cooling 
the atmosphere, when it is understood that water, on being 
converted into vapor, combines with more than five times 
the quantity of caloric that is required to bring ice cold wa- 
ter to a boiling heat, and occupies a space eight hundred 
times greater than it does when in the form of water.* It 
appears to be owing to the great diminution of evaporation 
from the surface of the earth, that a long continuance of 
drought in the summer is generally attended with very hot 
weather. 

We come now to another part of the subject in the pre- 
vention of fever, which, although like other innovations and 
discoveries, it has been disputed, as combating with the fa- 
vorite hypotheses and speculations of certain physicians ; 
yet the number and accuracy of the experiments, repeated 
'by distinguished and scientific gentlemen, who could not be 
suspected of gross prevarication, or of wilful and interested 
imposition, must convince the unprejudiced of their correct- 
ness and truth. I allude to the destruction of noxious mi- 
asms or infection by acids in a state of vapor, or, in other 
words, by acid fumigations. The efficacy of these fumiga- 
tions is now generally admitted among chemists, as well as 
scientific physicians. 

The power of mineral acids in destroying infection, was 
known to Sir John Pringle as early as 1750. And in 1758, 
Dr. Johnson published a pamphlet, in which he sets forth 
the efficacy of the vapor of the muriatic acid in destroying 
the infection of a malignant fever which raged at Kidder- 
minster in 1756. During the prevalence of a dreadful epi- 
demic at Seville, in 1800, in which more than twelve thou- 
sand persons perished, Mr. Queralto, one of the surviving 
commissioners appointed by the Spanish government to try 
the effects of the nitrous vapors, reported that the success 
exceeded the most sanguine expectations ; as the progress 

* Dr. Black heated a quantity of water in a strong phial, closely corked, 
till its temperature rose ten degrees above 21 2 Q , its usual boiling point. On 
drawing the cork quickly, a small portion of water rushed out in vapor, 
and the temperature of the remaining fluid sunk instantly to 212. Ten de- 
grees of caloric, therefore, had been absorbed by the quantity of vapor that 
escaped. Mr. Watt, by heating waler under the pressure of a strong iron 
vessel, raised its temperature to 400°; yet still, when the pressure was re- 
moved, only part of the water was converted into vapor, and the tempera- 
ture of this vapor, as well as that of the remaining; fluid, was no more than 
212; there were, therefore, 188° of caloric absorbed in an instant, by the 
formation of the vapor, which had no effect on the thermometer. 



Prevention of Fever, 2$1 

of the contagion was not only stopped from the day after ni- 
trons fumigations were adopted, hut no patient was after- 
wards attacked by the fever in any part of the hospital. — - 
We are further told that the fumigations proved also an ex- 
cellent medicine to the patients ; for all who lay in the wards 
where the fumigations were continued day and night, found 
instant relief, and most of them recovered within a few days. 
Instead of twelve persons dying every day in the hospital, 
as usual, before the employment of the nitrous vapors, the 
number decreased soon after to only one in a day.* 

But the person who has made the most extensive observa* 
tion upon this subject, and who may be considered as hav- 
ing essentially contributed to a new and valuable discovery 
in medical science, is Guitosi Morveau t M. Morveau's 
theory of fumigation had for its basis two weli known facts: 
1st, that all putrid decompositions produce a great quantity 
of ammoniac ; the 2d, that the muriatic acid and ammoniac, 
when they meet each other in a state of vapor, or gas, form, 
almost instantaneously, a neutral salt. The same thing is 
true with respect to the nitrous acid gas; and although we 
are not authorized to say that ammonia is, itself, the princi- 
ple of infection, yet we have every reason to conclude that 
the matter of infection is of an alkaline nature. J In rela- 



* Med. aril Phys. Jour. Vol. II. p. 136. 

+ See his Treatise on the Means of Purifying Infected Air, of Prevent- 
ing Contagion and Arresting its Progress. Mr. Braode, in his Third Dis- 
sertation on the Progress of Chemical Philosophy, pays a handsome com- 
pliment to Mr. Morveau. Speaking af this d:stinguished philosopher, he« 
observes, that "amidst various avocations, he prosecuted chemistry with 
successful diligence, and, had he given nothing else to science, his name 
deserves to be transmitted to posterity, as the inventor of the means of des- 
troying infection by acid vapors, the efficacy of which 1 he first pointed out 
in the year 1773" 

^ When it is intended to purify the air in the wards of a hospital, or of 
an infected apartment, a chafi ^g-dish or iron vessel of coals is used, and in 
it is placed an iron pot half filled with sand or ashes. On this sand bath, 
must be placed a glass vessel containing common salt, (mur.. sod ) and when 
the salt begins to be heated, sulphuric acid is to be poured upon it, after 
which the doors and windows of the ward must be kept as closely shut as 
possible, for seven or eight hours In other instances, says M. Guiton Mor- 
veau, several small vessels should be carried about the anartment, adding 
a small quantity of acid at a time. 1 his is the ordinary mode of disinfec- 
tion, by means of the muriatic acid gas. 

The oxygenated muriatic acid gas is still more powerful, and is prepared 
as follows : oz. drs. grs. 

R. Common salt, 3 2 10 

Black oxyde of manganese, 

Water, - 

Sulphuric acid, 
To which heat is to be applied, as above directed. 



5> 


5 


17 


1 


2 


33 


1 


• 


4U 



£82 Prevention of Fever, 

tion to the power of disinfection by means of acid fumiga- 
tions, it is related by Mr. Morveau, that the next day after 
fumigating a church, which had been filled with offensive 
and putrid effluvia, upon throwing open a door for the ad- 
mission of fresh air, not the slightest degree of any offensive- 
odour remained ; and all who were present went away con- 
vinced that the infection was completely exterminated. — 
Four days after, service was performed in it as usual, with- 
out any inconvenience being experienced. Numerous other 
experiments in purifying offensive and infected places, were 
made by the same author. Similar experiments and obser- 
vations have likewise been made by Smith, Brothwaite, Pat- 
terson, Bonvoisin, Martigni and others. And that this pro- 
perty which the muriatic gas possesses, does not consist in 
merely masking the disagreeable odours of infected places, 
they remarked that aromatics and other odorous substances, 
although they corrected, for a time, the disagreeable smell,, 
yet had no effect in destroying the contagion. 

M. Morveau infers that oxygen, and particularly the gas- 
eous oxyginaies, produce two effects of the same tendency. 
They exert on the contagious miasmata an affinity which de- 
composes them ; and they aid the living human body in re- 
sisting that power of assimilation, which renders contagion 
dangerous after it is introduced. According to the experi- 
ments of M. Morveau, aromatic vinegar, acetic acid, and 
pyroligneous acid, (acid of smoke,) possess the power of de- 
stroying putrid odours in a very considerable degree, though 
inferior to the muriatic acid gas.* 

The respirability and diffusive property of the muriatic 
acid gas, says Morveau, give it an advantage over the nitrous 
gas. He considers nitrous gas exceptionable, not only from 
its being liable to impurities, but by robbing the air of a por- 
tion of its oxygen. He thinks the oxygenated muriatic acid 
gas the best anticontagious substance with which we arc 
acquainted ; and may be breathed without the least incon- 
venience. 

The alkaline quality of the matter of infection would fur- 
ther appear from the following fact. Morveau found that 
when he submitted his reagents to the fumes disengaged by 
lime from the water which he had used in displacing the in- 
fected air, and which coming into immediate contact with 
the putrid flesh, had acquired a slightly reddish tinge; at 
the end of Iwo hours, the slips of paper covered with the fur- 

* Experiment XVI. and XXV. 



Prevention of Fever* 2i#& 

iium bucca, the mallows, and even the turmeric, gave une- 
quivocal signs of ammoniacai gas.* 

That quick lime possesses no power of disinfection, apy 
pears from this, that according to the experiments of M, 
Morveau, corrupted air possesses its noxious smell even af- 
ter being agitated with lime water. 

When the doctrine of Septon was in vogue, its abettors 
attempted to prove that the deleterious property of morbific 
effluvia, consisted in an acid, which they called septic acid, 
(from ihe Greek sepo, to putrefy,) because it was the result 
of putrefaction ; formed by the combination of nitrogen with 
oxygen, previous to their taking upon themselves the gaseous 
state. From which it appears that septic acid and nitric 
acid are one and the same thing.! As this hypothesis stands 
in opposition to direct experiment, it may consequently be 
considered as gratuitous and unfounded. 

* Morveau's Experiment?, p. 78. 

t No disrespect is intended towards Dr. Mitchell, to whom the world is 
indebted for this doctrine, by any observations which may be made in rela- 
tion to it ; his character as a man of science stands deservedly high, and his 
immense stock of reputation can sustain but little diminution, even by the 
loss of a favorite hypothesis. The Doctor calls azotic air, or nitrogen gas > 
by the name of septous gas ; dephlogisticated nitrous air, gaseous oxyd of 
septon ,• nitrous air, septic gas ; nitrous acid, septous acid ; nitric acid, sep- 
tic acid, &c. ike. Several of the ancients were of opinion that the poisonous 
exhalation from marshes was composed of minute animals, which being set 
afloat in the atmosphere were received into the body by the mouth and nos- 
trils, or insinuated themselves by the surface. I shall notice a few of these 
singular opinions, as quoted by Lancissi, in his treatise on the noxious steams 
from marshes. Among the Latins, we read that M. Varro speculated on this? 
subject, and ascribed the mischief to swarms of insects. "It is worthy of 
remark," he writes, " in marshy places, that as they dry up, there are pro- 
duced certain very small animals, too minute for observation by the eye; 
which being taken into the body by the mouth and nostrils, are the cause 
of difficult diseases." The ground-work of this opinion, (says Lancissi,) 
seems to have been laid by Lucretius, where he sings of physical truths in 
poetic strains ; " all bodies are liable to putrefaction; and animated insects, 
spring from that corruption." Not unlike the opinion of Varro, was that 
of Columella; who writes, " That a marsh ought not to be in the neighbor- 
hood oi buildings, nor near a military way, because, when acted upon by 
heat, it ejects a baleful poison, and engenders animals armed with trouble- 
some slings, which settle upon us in the thickest swarms. Then, too, it- 
emits the venomous hosts of water snakes and serpents, freed from their 
winter's slime, mud, and fermentative colluvies. And from these arise fre- 
quent obscure diseases, whose causes have not been investigated even by 
physicians." Palladio has expressed himself in nearly the same terms, 
where he says, " A marsh is to be avoided upon every principle, especially 
on the south or west, or if it usually dries up in summer ; because it gen- 
erates pestilence and hostile animals." Athanasius Kircher, in bis scrutiny 
of the plague, renewed the opinion of Varro: and when he recounts the 
causes of this woful malady, he mentions septic exhalations breathing from 
those places which abound with the filthy mud of marshes and pools. He 
affirms that these vapors are nothing more than«certain aerial particles of a. 



284 Prevention of Fever, 

It has already been remarked, that lime wafer possesses? 
no power in destroying infection, or putrid smells, which it 
should do, according to the doctrine of septic acid. The 
quality of lime in resisting putrefaction, is a property which 
it possesses in common with many other earthy and mine- 
ral substances, which, however, form no chemical combina- 
tions with the decomposing matter. 

Not only are the mineral acids correctors of noxious mi- 
asmata, but various other morbid poisons are also destroyed 
by them. Thus the nitrous vapor has been found an excel- 
lent and effectual remedy in cases of obstinate ulcers.* Va- 
riolous and vaccine matter, exposed but for a moment to the 
vapors of oxygenated muriatic acid, lose their contagious 
properties.! Halle, in 1787, conjointly with Fourcroy, 
made trial of the oxygenated muriatic acid in the case of a 
woman attacked by a large cancer in the breast. Though 
a cure was not accomplished, yet the simple application of 
clothes dipt in the acid produced a remarkable change ; the 
foetor was diminished, the colour improved, and the dis- 
charge became less sanious.J Mr. Cruickshank tried to in- 
oculate two subjects with a portion of the variolous poison, 
after mixing it with the oxygenated muriatic acid : the in- 
sertion produced no effect, whilst the other portion commu- 
nicated the variolous eruption. § M. Halle found that from 
the internal use of the oxygenated muriatic acid, prepared 
with the oxyde of manganese, hectic fever was suspended 
in a patient sinking under pulmonary consumption, and that 
she died without diarrhoea. Mr. David Patterson, on the 
nitrous vapor as a means of purifying infected places, ob- 
serves, that the nitrous vapor, with due attention to cleanli- 
ness, ventilation, changing the wards, &c. is seemingly the 
remedy, the best calculated for preventing, or speedily 
destroying contagion. He aleo found it efficacious in ca- 
ses of obstinate ulcers. || Dr. Bonvoisin found that the ace- 
tic acid acted as a preventive in putrid malignant, pestilen- 



mixt, of the same property and nature with the whole ; that they are des- 
titute of life, but soon change to innumerable insensible worm? ; so that as 
many corpuscules as there are in the effluvia, as many vermicuies will be 
hatched from them. These animated effluvia emit the more dangerous poi- 
son, in proportion to the greater vigor and energy they possess." 

* Patterson on the Nitrous Vapour, as a means of purifying infected pla- 
ces. Duncan's An. Med Vol. lit. p. 410. 

t Brothwaite on Scarlet Fever. Med. Jour. Vol. IV. 

$ Ann. de Chem torn. xxvi. 

$ Ibid, torn, xxviii. 

]} Dune. An. Med. Vol. III. p. 410. 



Prevention of Fever., 28p 

rial maladies, when its fames were inhaled by the organs of 
smell.* 

It is also upon chemical principles that we are to account 
for the salutary effects of the smoke of common fires, as a 
preventive of fevers in unhealthy situations. It is well 
known that one of the results of combustion is the pyrolig- 
neous acid, which, by combining with the noxious miasms, 
destroys their infectious property. " It is not to be doubt- 
ed," says Dr. Lind, " that excepting the true plague, there 
has been an infection fully as pestilential and as mortal, in 
some ships as in any other places whatever; yet I never 
beard of any ship, which, after having been carefully and 
properly smoked, did not immediately become healthy. "| 
The same author informs us, that when the fever was so 
mortal in the Royal Ann, a guard-ship at Spithead, that 
many died of it in forty-eight hours illness, with profuse 
bleedings from the nose, it was remarked that none who 
slept within reach of the smoke from the cook room were 
infected. J He further remarks, that the contagion of the 
small pox has been entirely stopped by means of wood fires, 
sprinkled with brimstone kept burning and closely confined 
in the infected pl?ce.§ ft is well known that the combus- 
tion of sulphur, in the atmospheric air, produces the sul- 
phurous acid gas, distinguished by its pungent and suffoca- 
ting odour; and from what has already been said with res- 
pect to acid fumigations, it will readily be perceived that 
the burning of sulphur or brimstone operates in the same 
chemical way in destroying infection. 

The remarkable exemption of the steam-ship Robert Ful- 
ton from sickness, notwithstanding her frequent passages to 
and from New Orleans, Havana and New- York, is to be as- 
cribed principally to the smoke, or the pyroligneous acid. 
The unusual healthiness of the crew of Captain Cook in the 
bark Endeavour, in his voyage round the world, may be 
brought in as another instance of the salutary effects of 
smoke in the prevention of disease. During this voyage 
through various latitudes, both of the frigid and the torrid 
zones, out of a company of more than one hundred and 
twenty persons, and during a three years' cruise, there were 
only four deaths, three of which were from accidents, and 



* Memoirs of the Academy of Turin, quoted by Morveau, on Disinfec- 
tion, p, 8. 

t Lind on Fever and Infection, p. 44. 
% Ibid, p. 49. 
& Ibid, p. 48. 



286 Prevention of Fever* 

the other from consumption of the lungs. It was the fre*- 
qbent practice of Captain Cook, to kindle a fire in the well ? 
at the bottom of the hold. 'In this way, upon closing the 
hatches, the smoke penetrated every part of the hold of the 
vessel, and the foul air being at the same time rarified by 
the heat, was in a great degree expelled, while that which 
remained was purified by the acid of the smoke, or the py- 
roiigneous acid. 

The known efficacy of the mineral acid gases, and par- 
ticular!} of the muriatic and oxygenated muriatic acid gases 
in destroying infection, and the local and limited origin and 
extent of this matter in the fevers Which prevail on ship- 
board, offer a valuable remedy to our navy in cases of ma- 
Rgnanl and fatal diseases arising from cruises in hot cli= 
mates; and there can be no question that had this remedy 
been resorted to on board the Macedonian frigate in the 
summer of 1322, the greatest part of the mortality which 
fpok place in that vessel would have been prevented. But 
new discoveries and improvements, however valuable, are 
slow in gaining credit. Attachment to former customs and 
the prevailing prejudice of opinion oppose no inconsidera- 
ble harrier to the progress of science and the dissemination 
of (ruth. The power which these acid gases possess of de- 
stroying infection, points them out as the most suitable and 
powerful agents in the purification of infected goods and 
aparlmeuts. Yvhere the infectious miasms are of limited 
extent, as in hospitals, or on sliip board, their application is 
as easy as their operation is effectual. Vessels, from cruising 
in tropical climates, often engender in the corruptible con- 
tents of their holds, as offensive bilge water and a perishable 
cargo, the principles oi malignant, bilious, or yellow fe\ei\ 
Next to removing the corrupting materials of disease, which 
is often a matter of difficulty and labor, nothing can be em- 
ployed with so much immediate benefit as the muriatic acid 
gas, which by neutralizing and destroying the infectious mi- 
asm? as they arise, prevents their deleterious and morbific 
effects. Where goods are suspected of containing the mat- 
ter of contagion, a (tee exposure to the open air is sufficient 
for their purification ; for, as has already been remarked, 
infection loses its virulence in proportion to its dilution and 
diffusion. 

From the limited extent of infectious miasmata, a means 
is suggested of avoiding their, influence, by removing, when 
practicable, beyond the sphere of their operation. Thus 
it has been found, in various instances, that ships lying at 
the distance of a few cable lengths from the unhealthy 



Prevention df Fever* 28T 

stjore, is a sufficient protection against disease. So, by re- 
moving to a healthy inland situation, although but a short 
distance from the seat of infection, will be sufficient to es- 
cape disease. Or if persons, immediately upon being seiz- 
ed, are removed to a healthy place, the danger of the disor- 
der is in a great measure obviated. Thus we are informed 
by Dr. Lind, that when the Lion, Spence, and several other 
ships of war, were employed at Port Antonio, in the island 
of Jamaica, in clearing the navy island of wood, in order to 
build wharves and store-houses in that place, many of the 
men, when cutting down the wood, were seized at once with 
a fever and delirium. This frenzy attacked a man so sud- 
denly, and with so much fury, that with his hatchet, if not 
prevented, he would have cut to pieces the persons that 
stood near him. By bleeding and sending them on board 
of (heir respective ships, they all quickly recovered.* 

Persons who reside in, or remove to, the dry and hilly 
parts of the West India islands, escape the endemic which 
may prevail in other parts of the island. Dr. Lind speaks 
of the healthiness of hilly situations in the West Indies and 
other countries, and the exemption of the French neutrals 
who were removed in 1756 from Nova Scotia, while they 
remained on Monk's Hill, in Antigua, although a great mor- 
tality raged in the rest of the island, particularly among the 
English, who were dying rapidly with the yellow fever and 
flux.t For instances in support of this fact, however, we 
need not travel far, since in our country it is universally 
found that the only healthy situations are those at a distance 
from low grounds, ponds, marshes and water courses, where 
the land is broken and hilly, or poor and sandy. And we 
frequently have occasion to observe the endemic fever pre- 
vailing with the utmost malignity on the rivers and low 
grounds, whilst at the distance of two or three miles, where 
the country is dry, hilly and poor, the inhabitants are per- 
fectly healthy. 

Every family in a town or city should be particularly at- 
tentive to the means of health in their own premises and vi- 
cinity. A proper descent and drain should be given to ail 
the water that may fall upon their lots, and not a particle 
should be left to stagnate and putrefy in sink holes and pud- 
dles; all places below the general level should be filled up 
with sand or gravel ; and the back yards should be raised 
with earth and sand, so as to give a sufficient descent into 

* Lind on the Dise?.ses incidental to Europeans 'in Hot Climate, p. lf$ 
tlbid, p.2J^ 



£88 Prevention of Fever.- 

the adjoining street. If the streets themselves are too level 
for the water to drain and flow from them with facility, this 
natural want of unevenness of surface should be supplied by 
art; the streets should be ridged up in the middle by draw- 
ing the dirt from both sides, and the side walks should be 
raised with sand and gravel, and paved with brick or stone, 
where this is practicable. The drains should all be suffi- 
cient to allow an easy flow to the water without suffering 
any stagnation. 

The proper season for draining stagnant ponds, is in the 
winter. If this is deferred to the summer, it had better be 
omitted altogether; for the action of the sun and air upon 
the corruptible materials left upon the surface of the earth 
from which the water has been recently drained or dried up, 
produces exhalations highly virulent and pestilential. This 
fact was illustrated, chap. 1 , pages 47 and 48, under the head 
of Miasmatic Exhalations ; where it was also shown, that 
overflowing offensive matters in such situations with fresh 
water, prevented or suspended the extrication of miasmata, 
and put a stop to the prevalence of disease. 

The limited sphere of miasmata puts it in the power of 
human care and industry to guard against and prevent, in a 
limited degree, their generation and influence : and if, as 
we all know, noxious miasms prove deleterious to life in. 
proportion to their strength and the vicinity to their source, 
the necessity of removing all nuisances within the precincts 
of our towns and individual habitations, must be too evident 
to require further illustration. It was from the wise coun- 
sels of Lancissi, that philosophic physician, that Rome, once 
the nursery of disease, was freed and preserved from the 
desolating visitations of the plague : the ponds and marshes 
in its vicinity were drained, and cleanliness was enforced in 
the city. It was from a similar attention to, and improve- 
ment of their police, that London was protected against the 
visitations of those pestilential diseases to which she had 
been frequently subject. If cities once obnoxious to such 
desolating calamines, can, by the prudence and industry of 
its inhabitants, be made perfectly healthy, what may we not 
expect from the same spirit and liberality in the improve- 
ments of places, now the scourge and terror of the people? 
Nature is every where governed by similar laws, and the 
physical causes of health and disease are subject to the same 
operations. Man has been constituted by his Maker the 
lord and master of this terraqueous globe ; and to him it was 
granted to make such alterations and improvements upon its 
rough- he w-q and disfigured surface, as mijjht be most condu- 



Cure ef Fever. 28$ 

cive to his happiness and enjoyment. In this way, by not 
being left the mere victim of sloth and sensuality, he becomes 
indebted to his labor for his welfare, and is yet sufficiently 
beholden to the Providence that rules the seasons to be sen- 
sible of his obligation and dependence. 



CHAPTER XIV. 
OF THE CURE OF FEVER. 

Preliminary Remarks, 

As I shall hereafter treat more particularly of the enden> 
ic fevers of Alabama, in this place I shall only make such 
observations on the cure of fever as may be of general prac- 
tical application to all endemic fevers of the southern states. 
In a practical point of view, this step will seem the more 
necessary, as in the account of any particular epidemic there 
are peculiarities of treatment which do not demand that sys- 
tematic detail and discrimination of circumstances required 
in delineating the treatment of endemics in general. 

The close connexion that exists between intermitting and 
remitting bilious fever, will render it necessary tv make a 
few remarks in relation to the former, previously to enter- 
ing upon the more particular treatment of the bilious re- 
mittent. 

SECTION I. 

Of the Cure of Intermitting Fever. 

In this fever, the object is to moderate the paroxysm when, 
present, and, when absent, to prevent its return. 

If called during the paroxysm of a fever and ague to a 
patient of robust and full habit, in whom the febrile action 
m 2 



290 Gure of Feverl 

runs high, it will be proper to have recourse to venisection 
The loss of twelve, or sixteen, or twenty ounces of blood, 
will generally afford instant relief to the patient. If the 
symptoms should not be such as to require the use of the 
lancet, the cure may bj commenced by premising an eme- 
tic, in the manner directed under the head of Prevention ; 
and in most cases this should follow the bleeding. 

In the intermitting fever, there is less danger from the 
exhibition of emetics than in the higher grades of bilious fe- 
ver; the prostration which sometimes follows the use of an 
emetic in the latter, need not be apprehended in the fever 
and ague; in which I have sometimes found it necessary to 
exhibit twenty or thirty grains of tartarized antimony before 
a sufficient operation could be excited. Rut the same quan- 
tify given in the bilious remittent, though not operating se- 
verely, would, in many instances, be followed by an alarm- 
ing and perhaps fatal prostration of the- system. 

Tartar emetic, given in divided doses, shortens the par- 
oxysm, by accelerating the flow of perspiration ; and when 
it has ceased to operate as an emetic, it often acts as a ca- 
thartic. Warm drinks should be given freely during the 
operation of the emetic, and thin gruel or weak tea of al 
most any description during that of the cathartic* 



* We find the utilit)* of the emetics and the tartarized antimony as a re- 
medy in fever and ague strongly insisted upon by a variety of authors. We 
are informed by Galen, that many were cured by this remedy alone. In all 
case?, says Celsus, when the febrile paroxysm is introduced by a coldness 
and shiveriug, vomiting is necessary. The utility of emetics is also strongly 
insisted upon by Paul us jEtius. And amongst others of a more modern date, 
Riverius speaks in the highest terms of their efficacy, considering them more 
certain and useful than any other remedy. As connected with this subject, 
Etmuller makes the following observations. "If pain of the stomach ac- 
companies fever, nothing equals antimonial vomits, which prevent an infin- 
ity of dismal consequences. After vomiting, purges are proper ; but by rea- 
son of their offensiveness to the stomach, let 'em he mixed with opiates; a 
useful contrivance for such as are liable to griping, or over purgations, or 
stuffed with sharp, scorbutic, hypochondriacal humors." Seuac also gives 
testimony to the efficacy of emetics. ; ' Emetic medicines," sayp he, " arc, 
indeed, so efficacious in interraittcnts that they often times bring them to a 
close as it were by a single blow Many practitioners in marshy countries 
err in this, that they place too little dependance on emetics. Such is the 
efficacy of these remedies against fevers, that I have used them as prophy- 
lactics, to escape an attack " ♦' Nothing is more proper," says Huxham, 
" to eradicate intermittent fevers than frequent vomiting. The Romani of 
old vomited themselves out of mere luxury, that they might eat the more 
heartily : why should we not therefore do it for the sake of health." Hux- 
ham on Fever, Vol. I p. 28. 

It was observed by Fontana, that the dogs arid cats which he had poisoned 
recovered with a facility proportioned l» the viol«a«e of the vomiting".-*- 



Curt of fove'r. 2-91 

It* the emetic does not act upon the bowels, it should be 
followed by the exhibition of a cathartic. Provided the 
patient can retain it, there is no objection to the usual pur- 
gative, calomel and jalap; but that which I have found 
equally, and often more effectual and serviceable, and at 
the same time less nauseating a? a cathartic, is calomel and 
castor oil : the calomel may be mixed and given in a spoon 
with a little syrup, and the castor oil soon or immediately 
afterwards. Jalap and cream of tartar are also an excel- 
lent purgative, and where there is much fever present, as 
well, or better calculated to answer the purpose than any 
other. 

We are informed by Sir John Pringle, that Dr. Saunders 
exhibited rhubarb and senna with success in several cases 
of obstinate intermittents. And that Mr. Drummond, sur- 
geon, hearing of Dr. Saunders' practice of giving tincture 
of senna and rhubarb about seven hours before the coming 
on of the paroxysm, tried it on himself and thirty soldiers 
with success.* 

After the paroxysm has subsided, we should endeavor to 
prevent its return, by stimulants and tonics. Of the latter, 
Peruvian bark and the white oxyde of arsenic are the most 
effectual. The bark should be taken during the intermis- 
sion in as large quantities as the stomach can bear, mixed 
either with pure water or a little wine or spirits. From 
one to two drachms may be taken in this way every two 
hours. Where the intermissions are long, it will be better 
to defer the use of the bark till within five or six hours of 
the expected paroxysm, and then take it freely every hour 
or two hours, and in such quantity as the stomach can bear. 
When the stomach is weak, or nauseates the bark by itself, 
aromatics may be added, as cinnamon, cloves, mace, &c. ; 
should it be rejected even in this way, the bark may be given 
in the form of watery infusion in combination with the same 
articles. 

When the disease assumes a malignant aspect, and the 
paroxysms become more frequent and protracted, the bark 
must be exhibited frequently and in large quantity. On 



J -' And wishing,' ' says he, u to follow this indication of nature, I made a great 
number of experiments on dogs. I was very often led to believe the emetic 
a good remedy, as I sometimes met with seven or eight cases which termi- 
nated in the same way and were altogether favorable." Fontana on Poi~ 
tons, Vol, IL p. 10. 

* Sir John Pringle, Med. Annot. Vol. VII. p. 63. MS. as quoted by Gar- 
diner. Anim. Econ. p. 448, 



,2f 2 'Cure of FeveK 

9ome occasions it will be desirable and necessary to take 
two or three ounces between the paroxysms.* 

It sometimes, though rarely happens, that the bark fails 
to effect a cure ; sometimes the patient is unable or unwil- 
ling to take it; in such cases, I have generally succeeded 
with the oxyde of arsenic either in solution or substance. — 
Twelve drops of Darwin's saturated solution may be given 
three times a day. I generally, however, prefer giving it 
in the form of pill ; combining one third or the fourth of a 
grain of arsenic with a quarter of a grain of opium, of which 
the patient is directed to swallow one every four hours, till 
the quantity of two or three grains of arsenic has been ta- 
ken. To obviate any unpleasant effects that may arise from 
the use of this article, a cathartic may be subsequently ex- 
hibited. Bark, however, when the patient can be prevail- 
ed upon to take ft, I have always found much more certain 
and effectual than arsenic, and is moreover free from the 
danger that sometimes attends the exhibition of of this min- 
eral poison. 

The paroxysms may likewise be prevented from return- 
ing, by the use of diffusible stimuli ; of these, the most effi- 
cacious appears to be opium. This may be given either in 
the form of pill or tincture. About two grains taken an 
hour and a half before the time of the expected paroxysm 



* The environg of Modena wer© formerly subject to a class of diseases, 
which Torti has denominated malignant fevers, inasmuch as they carried off 
the patient during the third paroxysm, and even when he v/as considered 
out of danger. Debility, drowsiness, and excruciating head-ache, were the 
principal symptoms oi these fevers, between which and those of Egypt, says 
Assalini, there exists a strong resemblance. At this day the malignant fe- 
vers of Torti have either disappeared altogether, or are become very rare. 
This change has been attributed to the filling up of the ditches and marshes 
"which surrounded the city and citadel of Modena; the corrupt waters of 
which occasioned exhalations which infected the air. w The celebrated 
Torti," says Assalini, "has taught us the mode of curing this disease as if 
by enchantment, by means of Peruvian bark, given in large doses frequent- 
ly repeated. I had an opportunity of seeing and treating this disease near 
Mantua ; its course is so rapid and its symptoms so violent, that in order to 
stop its progress I was always obliged to give three ounces of bark mixed 
with wine or water, in the course of twenty-four hours, between one par- 
oxysm and another ; and when the patient was weak, I did not omit adding 
more or less of liquid laudanum, according to the state of the constitution. 
Those physicians, says he, who from a dread that this practice will over- 
heat, or cause obstruction, pre/er the use of refrigerants, or purgatives, in 
order to evacuate the bile, have constantly the mortification of seeing their 
patients carried off as if apoplectic, and in a very short time ; and if they 
escape, often suffer from fever for several months, thry at length become 
dropsical, which they never fail to attribute to the bark which they are too 
late in prescribing.' ' See the Appendix to Assalini on the Plague. Amer. 
Edit. p. 200. 



itkire of Fever. %tt& 

will generally succeed in preventing its return ; or fifty or 
sixty drops of laudanum may be given instead of the opium, 
with the same effect. The efficacy and certainty of this 
remedy will be increased, if, after taking it, the patient goes 
to bed, and drinks freely of some warm mint, sage, or snake 
root tea. For the same purpose that we employ laudanum, 
paregoric may be substituted ; and as being more disposed 
to excite perspiration, it has perhaps an advantage over lau- 
danum or opium alone. Two, three or more tea spoonfuls 
of this may be given to an adult an hour or two before the 
ague is expected, with the employment of the other means 
recommended in the use of opium. 

A variety of articles are sometimes substituted for the Pe- 
ruvian bark, such as quassia, gentian, columbo, the cherry, 
dogwood, black oak bark, $*c. ; some of these I have some- 
times had recourse to for want of the Peruvian bark, but 
their virtues are trifling and inconsiderable when compared 
with this valuable medicine,* 



SECTION II. 



Of the Operation of the Remedies employed in Intermitting 

Fever. 

By observing that the paroxysms of intermitting fever are 
terminated by sweating, we are led to the conclusion, that 
the subsidence of the fever is essentially connected with 
this evacuation. And as the most obvious inference, we 

* For the preventing the return of the paroxysm of fever and ague, Cel- 
8us recommends the following practice — which, by the by, it may be ob- 
served, is much superior to many popular remedies and expedients of the 
present day. " When the third fit is expected, which may possibly tome 
on, the patient must be brought to the bagnio, and care must be taken that 
he be in the bath at the time of the shuddering. If he have felt it there 
also, let him do the same, nevertheless, when the fourth fit is expected ; for 
by this repetition it is often removed. If the bath proves unsuccessful be- 
fore the fit, let him eat garlic, or drink hot watei with pepper : for these 
two raise a heat, whi:h repels the shuddering. After that, before the shud- 
dering has time to come on, let him cover himself up in the manner above 
directed under the article of coldness : and it is proper immediately to apply 
all around his body pretty hot fomentations, and chiefly extinguished tiles 
and coals wrapped up in cloths." Grieve' s Celsus, B. Ill c. xii. p. 138.— 
This practice was in part imitated by Sydenham, who to prevent the re- 
turn of the paroxysms of autumnal tertians directed the patient to be pla- 
ced in bed and well covered with bed clothes ; and for the purpose of exci- 
ting perspiration prescribed milk whey, with the addition of sage tea, foiD 
tours before the approach of the paroxysm. 



264 {Jure ofFkver* 

are induced to believe that the immediate cause of the fe- 
ver itself is expelled with the perspirable matter. In fur- 
ther support of this opinion, it may be remarked, that the 
sweat in fevers has often been observed to possess a strong 
pungent taste and smell. 

The utility of blood-letting in the hot stage of fever, may 
be ascribed to several circumstances resulting from its em- 
ployment. In the first place it lessens the strength and ac- 
tivity of the circulation by the abstraction of stimulus from 
the arterial system. As the blood is the natural stimulus of 
the heart and arteries, every diminution in the quantity of 
this fluid must, under ordinary circumstances, diminish the 
strength of their contractions, and produce a corresponding 
abatement in the force of the circulation. As it is in a great 
degree the force and activity of the circulation which oc- 
casion the preternatural heat in the paroxysm of fever, so a 
reduction in the impetus and celerity of the circulating flu- 
ids will produce a corresponding diminution of the fever; 
whether this diminution is occasioned by blood-letting, a ca- 
thartic, or the cold bath. 

Another effect of the abatement of the circulation is the 
production of a perspiration. We know from experience, 
independent of all reasoning or theory upon the subject, 
that a very hot state of the surface is attended with a con- 
striction of the amaller vessels and a parched and dry skin. 
Blood-letting, by subduing the force of the circulation, mod- 
erates the heat of the surface and relieves this constriction 
of the extreme vessels, thereby giving exit to the perspira- 
ble matter. Sometimes the effects of bleeding are dispro- 
portionate to the quantity that has been drawn. Where a 
large orifice has been made, and the blood has flown freely, 
the sudden abstraction of twelve or sixteen ounces of blood, 
or even a less quantity, often brings on a faintness, with a 
weak and irregular and sometimes an intermitting pulse. — 
It appears that in such cases the blood vessels have not had 
sufficient time to adapt their dimensions to the lessened vol- 
ume of the circulating mass; but retaining for a short time 
their original capacity, the blood is not firmly embraced by 
the sides of the arteries, and of course does not feel the full 
force of their contraction. This effect is apt to take place 
in persons of full habits and robust constitutions, and might 
afford matter for alarm to the young and inexperienced ; 
he, however, soon has the satisfaction to find that this weak- 
ness and irregularity of the pulse lasts but for a short time, 
being, in all probability, soon followed by a free and gen- 
eral perspiration and an abatement ©f all the symptoms ; 



Cure of Fever. 295 

and even in cases of remittents is succeeded by a complete 
intermission or apyrexia. It sometimes happens that bleed- 
ing, instead of weakening, raises the pulse, increasing the 
strength and fulness of the circulation: we may here sup- 
pose that the heart and arteries were previously oppressed 
and overloaded, the quantity to be moved being dispropor- 
tionate to the moving power; by diminishing the load by 
which they were oppressed, the heart and arteries are ena- 
bled to rise and act upon the remainder; insomuch, that a 
second, third, and a fourth bleeding are sometimes required 
to bring about an equilibrium between the stimulus of the 
blood and the irritability uf the vessels. In cases of typhus, 
the action of the arterial system is weak; or if the pulse is 
full, it is destitute of strength; the fulness appearing to be 
occasioned more by the relaxation of the artery than by the 
actual vigor of the circulation. Here there is an actual de- 
bilitated condition of the muscular fibre, as the cause of this 
lessened vigor of the circulation and this torpor of the ner- 
vous system. As the debility and want of energy in typhus 
does not depend upon an overstrained plethora of the ves- 
sels, but are occasioned by an absolute diminution of the 
vita! principle, consequently blood-letting under such cir- 
cumstances can be productive of no benefit, but on the con- 
trary must prove very injurious. I have never, in rny own 
experience, or in my observation of the practice of others, 
found the least benefit from the employment of blood-let- 
ting in the typhus or asthenic stage of fever, however strong- 
ly recommended by Dr. Rush, who, in his simplification of 
diseases, endeavored to introduce a corresponding simplici- 
ty of treatment ; a treatment as unfounded in theory in rela- 
tion to typhus, as it is injurious and destructive in practice. 
Though the system is freed from a portion of morbid matter 
in the blood that is drawn in venisection, yet the quantity 
in this way extracted bears so small a proportion to the 
whoie, that but little of the benefit of this operation can be 
ascribed to this circumstance. The utility of blood-letting 
appears, principally, to consist in moderating the violence 
of the excitement, thereby preventing an undue engorge- 
ment, and a lesion of the vital organs and other viscera 
ef the body, in bringing about the operation of the different 
functions, and more especially in restoring the perspiration, 
and thereby enabling the system to throw off the morbific 
matter. 

The manner in which emetics prove serviceable in inter- 
mitting as well as in remitting fever, appears to be the power 
fhey possess of evacuating morbid matter from the system. 



2^ Qurt of Fever. 

This is very evident, as it respects the bile and other offen- 
sive matters rejected from the stomach; which, as already 
observed, in all probability contain a great share of the mor- 
bid poison, determined from the other parts of the body to 
the liver, as their proper and natural emunctory. The per- 
spiration, which is often excited by their use, acts upon the 
same principle in relieving the system from the excessive 
accumulation of hurtful and excrementitious matters. 

As it respects the operation of cathartics, it is merely ne- 
cessary to remark, that their utility is derived from their 
power in effecting the expulsion of offending matter. In fe- 
vers, the stomach and bowels are the general reservoirs of 
morbid accumulations; hence the necessity of preventing 
the formation of such collections, which in bilious cases 
cannot fail to prove highly detrimental, and to aggravate 
and prolong the continuance of the fever. 

As has already been observed, the paroxysm of intermit- 
ting fever is ushered in by an affection of the nervous sys- 
tem ; inconsequence, it is presumed, of the morbid matter 
acting upon the brain and nerves through the medium of the 
circulating fluids. Now, as this affection of the nervous 
system is owing, in some measure, to an undue degree of 
irritability, it is obvious that by diminishing this state, the 
system will be rendered less irritable, or altogether insensi- 
ble to the morbid stimulus. Accordingly, it has been found 
by extensive experience that a large dose of opium, exhibit- 
ed a short time before the expected recurrence of the par- 
oxysm, has in many instances altogether prevented its ap- 
pearance. The application of tobacco to the pit of the sto- 
mach, has also produced the same effect according to Dr. 
Tissot, who observes, " Dr. Monteith first mentioned to me 
that he had succeeded in stopping the fit, by putting a quan- 
tity of tobacco to the pit of the stomach, so as to occasion 
nausea and faintness at the moment of the invasion of the 
cold stage. I made trial of it in several instances, and met 
with equal success.' 1 * It should be remarked, however, that 
where the cause of fever is strong and virulent, and this dis- 
ease is disposed to malignancy, the exhibition of opiates, 
diffusible stimuli, or narcotics in any form, is neither safe 
nor effectual, except m moderate quantities only ; for though 
they should have the effect in preventing the recurrence of 
the chill or ague, yet as the offending cause is not removed, 
it acts with a deadly weight upon the system. This will be 

^Tissot on Ferer, p. 70. 



{Jure of FtveKc £97 

more especially the case where the stomach and bowels are 
loaded with offensive colluvies. 

We know that debility and irritability are in many instan- 
ces inseparably connected, and this is particularly observa- 
ble in invalids subject to intermitting fever. Therefore, by 
giving a degree of artificial tone and vigor to the system, 
its irritability will be diminished; and as the excretions 
are increased and rendered more healthy and perfect by 
the remedies employed, the morbid matter is eliminated in 
due time from the mass of circulating fluids. In this way 
appear to operate the vegetable and mineral tonics, as Pe- 
ruvian bark, bitters, arsenic. &c. These remedies, also, 
have a very considerable effect in promoting perspiration 
and the other natural excretions of the body. In this way 
I have frequently observed one or two doses of bark abate 
and carry off the lingering paroxysm of a fever, in which the 
skin, previous to its exhibition, was dry and crisp. tk Some 
contend," says ASibert, "that the bark produces its most 
salutary effects without exciting any critical evacuation. — 
But Albertini is of a different opinion. (De Bonon. Scient. 
et art. institut. at que Acad, comment.) He maintains that 
he never saw a fever effectually removed by this remedy 
without being followed by a crisis, similar to that which na- 
ture, or if the idea may be more acceptable, which other 
remedies generally produce. Albertini ascribes to the bark 
the power of producing not only sweat, stools and urine, but 
also of increasing the insensible perspiration; and in con- 
firmation of this latter opinion, he adduces a multitude of 
facts/'* Mr. Cleghorn, in his treatise on the diseases of 
Minorca, observes, that "the great advantage which occurs 
from the early use of the bark in tertians is, that it invigo- 
rates the powers of the body, prevents or removes the dan- 
gerous symptoms, and brings on a crisis soon, and with little 
disturbance. Instead of suppressing any beneficial discharge, 
as some have asserted, we daily observe a laudable separa- 
tion in the urine, warm, profuse, universal sweats, plentiful 
bilious stools, and sometimes the haemorrhoids and menses 
come on after it has been used ; though it effectually re- 
strains the colliquative night sweats, to which persons weak- 
ened by tedious intermittents are incident."! 

It may be objected to the doctrine of morbid matter in 
the fluids as the cause of fever, that the paroxysms of inter- 
mittents often continue to recur for several weeks, and even 

* Alibert on Malig. Intermit, p. 250. 
t Diseases ©f Minorca, p. 206. 

N 9 



298 Cure of Fever. 

months, after a removal to a healthy situation. Though 
this may serve to prove that unassisted nature is nota!vva)S 
able to effect a speedy cure, it by no means establishes the 
conclusion, that the paroxysms are not occasioned by the 
same internal condition of the system which first gave rise 
to them. It has already been remarked as highly probable 
that the morbid matter is not entirely eliminated from the 
body at the end of every paroxysm, but only so much of it 
as to render the remainder in some degree compatible with 
the healthy functions of the animal economy. But, as has 
already been shown, this matter possesses the power of as- 
similating a portion of the fluids to its own nature, so that 
when an excess of morbid assimilation again takes place, 
the paroxysm will in like manner be repeated. It appears 
that a very small quantity of morbid poison is sufficient to 
occasion disease by the power of assimilation ; and in order 
to prevent this, it is necessary to give a degree of artificial 
strength or insensibility to the system, and to enable it to 
effect the expulsion of the morbific matter. 

\ certain degree of the assimilation of the materials of 
disease is necessary to disorder the healthy functions of ihe 
animal economy: if this assimilation is inconsiderable, no 
inconvenience of moment arises; if greater, occasional in- 
dispositions are experienced ; and if in morbid excess, fever 
developes itself with all its characteristic features. We 
know that a certain time, longer or shorter, in different ca- 
ses, is required after exposure to infection before the per- 
son becomes affected with disease ; during this time the pro- 
cess of assimilation is going on ; but the materials of disease 
may be prevented from accumulating by the timely use of 
evacuating remedies ; or by such as increase the action and 
vigor of the excretory organs, and diminish the irritability 
of the general system. 



SECTION III. 

Cure of Remitting Fever* 

In the bilious remitting fevers of the southern states, there 
is generally a considerable degree of vascular excitement 
present at the commencement, and which frequently re- 
quires the employment of the lancet for its removal. In 
the use of this remedy, however, several circumstances are 
to be taken into consideration ; as the degree of vascular 



Cure of Fever. £99 

action, and the violence of the fever; the condition of the 
patient, as influenced by age, previous health or indisposi- 
tion, habit of body, &c. ; the nature of the epidemic, as be- 
ing more or less disposed to typhus or collapse, or to assume 
the inflammatory character; the season of the year, &c. 

I would just premise, before going into the detail, that 
there are probably but few places or seasons in the south- 
ern states, where the prudent employment of blood-letting 
would not be found serviceable in the commencement or 
progress of summer or autumnal fevers. Upon the use of 
blood-letting in the fevers of hot and tropical climates, much 
diversity of opinion exists among physicians. 

Dr. Clark* disapproves of bleeding in hot climates, ex- 
cept in strangers, where he considers that a moderate bleed- 
ing is admissible. 

Pringle observes that bleeding is dangerous, except in 
recent cases, and in strong full habits.t 

Hunter disapproves of blood-letting in the fevers of Ja- 
maica, even when the symptoms are high; "but if it was 
copious," he observes, " or repeated a second time, it was 
hurtful. "| 

Upon this subject, Burserius makes the following obser- 
vations. " But in the summer season, when the quantity of 
blood is less, on account of its most subtile parts having 
been converted into vapor; when all the fluids incline to 
become thinner ; when they manifest the greatest propen- 
sity to alkalescence and corruption ; and when the bile is 
more copious and warm than usual ; we must not have re- 
course to bleeding rashly. "§ 

We are informed by Dr. Chisholm, in his account vfi what 
he calls the malignant pestilential fever of Granada, that 
blood letting was employed with fatal consequences. u In 
the present instance," says he, k ' the ardent heat of the sur- 
face, the oppressed hard pulse, the pain of the side, the op- 
pression at the precordia, the headache, and the throbbing 
of the temples, seemed strongly to indicate the use of bleed- 
ing. Although the blood drawn was remarkably florid, and 
always threw up an inflammatory crust of greater or less 
thickness ; and although the pains seemed to undergo a tem- 
porary mitigation, yet the consequence, at the expiration of 
a few hours, was always fatal. I was the more surprised at 

* On the Diseases which prevail in Long Voyages, p. 121. 

t Diseases of the Army. 

t Diseases of Jamaica, p. 148. 

k Institutes of the Practice of Medicine, Vol. I. p. 25& 

v 



SQD Cure of Fexez-* 

this, (he continues,) as the patients were remarkably robust^ 
florid, and generally in the vigor of life." 

So much against bleeding in the fevers of hot climates: 
but on the other hand, there are a number of the most res- 
pectable physicians who speak of blood-letting in the warm- 
est terms of approbation. 

Hippocrates recommends bleeding in acute diseases, if 
the complaint is of an aggravated character, the patient 
young and of a robust constitution.* 

The principal dependance of Dr. Rush in ihe cure of the 
bilious remittent fever of Philadelphia in 1793, was upon the 
lancet. 

Dr. Jackson,t who had extensive opportunity for observa- 
tion on the nature and treatment of bilious diseases in the 
West Indies, says it is no unusual thing to observe that per- 
sons debilitated to the last extreme, that is. persons in fever, 
who were as it were paralyzed, and incapable of producing 
a single action of effect, rise instantaneously into full force 
and vigor, in consequence of a copious bleeding. The mode 
and measure of his practice are similar to those of Dr. Rush. 
The blood, he informs us, should be drawn from a large ori- 
fice, not measured by ounces, but allowed to flow till the 
end is obtained, the symptoms relieved, perspiration, sick- 
ness, vomiting, evacuations by stool, or faintness ensue. — 
Dr. Jackson, however, had recourse to the lancet with some 
discrimination. " In the commencement of fever," says he, 
" when the disease declares itself by the symptoms of a par- 
oxysm violent and in form, or only by headach and general 
uneasiness, the author has been in the habit, particularly in 
times of sickness, and in subjects lately arrived from Eu- 
rope, to order blood to be drawn from the arm to the amount 
of twenty ounces or upwards. This, followed by a dose of 
physic, salts, and emetic tartar, or calomel and James' pow- 
der, is frequently sufficient to remove the complaint." In 
many cases, he tells us, the loss of less than thirty ounces 
will not answer. He even recommends bleeding where the 
symptoms are such as to deter entirely an ordinary practi- 
tioner from it, and where, could we judge from the symp- 
toms, its employment, if not decidedly hurtful, would at least 
be of equivocal utility. "If the pulse be small," says he, 
" contracted, confined, obstructed, even imperceptible, with 
a dry, withered and impervious skin, or a skin greasy, damp, 
and clammy, a countenance livid, respiration hurried and 

* De Rat. Vict. In Morb. Acut. Opr. Om p. 395. 
t Outline ©f the History aad Cure of Fever, p. 264 



"Cure of Fever. . 301 

oppressed, without local pain, a condition supervening sud- 
denly, or arising under the use of stimulating powers, the 
loss of thirty ounces of blood or more, has often been unex- 
pectedly followed by a developement of the action of the 
vascular system : even petechias, vibices, and lividnesses 
have disappeared inconsequence of it, the pulse emerging, 
and a copious fluid perspiration ensuing. It must, however, 
be remarked, that where these fortunate events took place 
from bleeding, stimulating means of great power always 
made a part of the process." 

Most practitioners have probably observed, in some part 
of their practice, the sudden sinking of the pulse from bleed- 
ing, and the coldness and faintness which speedily super- 
vened. Such symptoms call for the use of stimulants, and 
wine should be given in moderation till they are removed. 
It is remarked by Dr. Jackson, by way of caution, that 
though bleeding is a remedy of great value in certain con- 
ditions of the fevers of tropical countries ; yet, that it is also 
in many cases a remedy, not only unnecessary, but improper, 
and even dangerous. It is unnecessary, he informs us, when 
the disease is of a distinct intermitting or remitting form, 
when the paroxysms are regular in all their parts, and ter- 
minate by copious perspiration, with softness, warmth, and 
sensibility of skin; it is improper, where the skin, bathed 
in fluid perspiration, seems to be of an increased sensibility ; 
when the pulse is lax and weak, is easily disturbed by chan- 
ges of posture ; and where fainting occurs from an increase 
of mobility, rather than from torpor. 

Upon the subject of blood-letting in yellow fever, Dr. 
Moseley observes,* that "it is not a few ounces of blood, 
however well timed, and if not well timed bleeding should 
not be performed at all, that will answer the end in the yel- 
low fever or in plague. * * " Such people only reprobate 
bleeding in pestilential fevers who never saw it used in a 
proper manner. It has cither been performed on improper 
subjects, or too late, or in too small quantity, and when the 
practitioner has stopped at one, or two bleedings, where five 
or six, or what I have often known ten or twelve, ought to 
have taken place. " 

Dr. M'Lean, in his inquiry into the nature and causes of 
the great mortality among the troops in St. Domingo, re- 
marks, that even feeble persons who may have resided for 
some time in a hot climate, if they are seized with acute 
diseases he can see no impropriety in blood letting. "If 

• Medical Tracts, p. 225. 



302 Cure of Fever. 

blood-letting," he continues, " produces good effects, which 
I believe it does in most instances, it must be performed 
very early in the disease, and be performed with boldness,"* 

In the fevers of Jamaica, Lempriere recommends blood- 
letting before the disease is complete!) formed, and is of 
opinion that if it were adopted the first moment the patient 
begins to complain, in many instances a total stop would be 
put to the progress of the fever. " As to blood-letting, 
however, after the disease is formed, (he observes,) I have 
given the practice such repeated trials, and there are prac- 
titioners in Jamaica as well as myself, who can vouch for 
the fatality of its consequences.! 

In the yellow fever, Hillary recommends bleeding in the 
first three days, to moderate the violence of the circulation. 

Clark says bleeding was dangerous or fatal if employed 
after the first thirty-six hours, though in young people it 
might be admissible to a certain extent at the commence- 
ment/]: 

It is observed by Baron Larrey, that in the yellow fever 
of Egypt, a small quantity of blood taken from the arm was 
serviceable ; but that copious blood-letting was fatal. § 

Leaving these various opinions to their own counterpoise 
and balance, it may be observed that in the use of the lan- 
cet there are some sure and certain indications which can 
never be mistaken. If the physician, called at an early 
stage of the disease, finds the patient young, florid and ple- 
thoric, with flushing of the face, redness of the eye*, pain in 
the head and back, hot, dry and caustic skin, much thirst, 
white furred tongue, and a pulse frequent, full and strong, 
or small and wiery, he will not prudently hesitate to have 
immediate recourse to blood letting ; which, although I have 
seldom thought proper to carry to the extent recommended 
by Dr. Rush and Dr. Jackson, should still be sufficient to 
moderate the symptoms and produce a change in the action 
of the vascular system ; when these changes are observed 
to take place, our object in the employment of the lancet is 
accomplished. During the flow of blood the finger should 
be occasionally applied to the artery of the disengaged arm, 
to observe the changes which take place from the loss of 
blood. The pulse becoming softer and slower, or even more 
frequent but free from tension, the pains abating, or the skin 

* M'Lean's Inquiry, p. 131. 

t Diseases of the Army in Jamaica, p. 118. 

X On the Yel. Fev. of St. Domin. Dune. An. Med. Vol. Vol. II. p. 165,. 

9 Larrey's Memoirs, Amer. Edit. Vol. I. 



iikire of Fever. 303 

appearing moist and perspirable, are the symptoms which 
govern, in a considerable degree, the quantity to be taken. 
It is evident, however, that much will depend upon the stage 
of the disease and the circumstances of the patient. I have 
sometimes found it necessary in persons of strong and robust 
constitutions, or of plethoric habits, to draw blood to the ex- 
tent of twenty or thirty ounces before a favorable change 
could be obtained. On other occasions I have found ten, 
eight, or even four or five ounces sufficient. When the bleed- 
ing is pushed beyond the extent which the symptoms require, 
an unnecessary and hurtful degree of debility is produced. 
It is better to have recourse to this remedy at several times 
successively, should the disease require it, than to extract 
more blood than is necessary at a single operation. 

The more inflammatory the symptoms, the greater will 
be the necessity and benefit of bleeding. In endemic fever 
there is often a congestion of blood, or a degree of inflam- 
mation in some of the internal viscera, as the brain, lungs, 
liver, spleen, stomach, &c. This is frequently the case even 
when no considerable degree of pain or uneasiness of the 
affected part is complained of. In such cases, the blood, 
when it has flowed freely from a large orifice, is found to 
exhibit the buify or inflammatory crust upon its surface. In 
instances of this nature it is frequently necessary to repeat 
the bleeding several times, and in proportion to the demand 
and urgency of the symptoms: when these are such as first 
authorized and required the use of the lancet, the remedy 
should still be repeated, even to the seventh or eighth time : 
or if blood-letting has been neglected at the commencement, 
and the state of the patient should be such as to require it 
at a subsequent period, we may safely have recourse to it 
at any stage of the disease. If asthenic symptoms, however, 
have made their appearance ; if the strength be prostrated ; 
if faintness and disposition to syncope come on from the pa- 
tient's being raised to an erect position, though the pulse 
upon slight pressure of the finger be full and regular, yet 
easily disturbed, becoming irregular, weak and faltering, 
upon a change of position or from an erect posture; if the 
heat of the surface and extremities be moderate, or below 
the healthy temperature, though intense and burning at the 
pit of the stomach, either to the sensation of the patient or 
to the feeling of the physician; should the head even be 
considerably affected, with derangement and alienation of 
mind, or should there be considerable palpitation of the heart 
at the same time, under such a combination of all or many 
of these symptoms, we must refrain from the use of the Ian- 



-3.04 "G'are of Fever i 

eet. Though from such a state the patient sometimes rece 
vers, jet the employment of blood-letting would be sure to 
hasten the fatal termination : the sensibility and power of the 
arterial system being already too much exhausted, and by the 
abstraction even of a moderate quantity of its natural stimu- 
lus the patient would be prostrated below the reclaiming 
powers of medicine. Dr. Lind observes that bleeding is 
always dangerous in proportion to the violence of the taint, 
and thai fevers highly malignant will not bear bleeding. — 
Many practitioners, from an undue prejudice in favor of this 
remedy, have recourse to it with indiscriminate hardiness in 
every variety of type and stage of fever. Such, in a great 
measure, was the practice of Dr. Rush, who could find ar- 
gument and reason for every error of opinion. " I have 
seen, 1 ' says Dr. Fordyce,* "in the hospitals of France, a 
fourth or fifth bleeding ordered in the last stage of fever with 
delirium? and black tongue, and teeth covered with a black 
tenacious slough, in a word, with the pathognomonic signs 
of putrefaction and malignity. A speedy dissolution was the 
consequence, as might naturally be expected." In page 71 
he adds, " Though I believe it will hold pretty universally, 
that fevers truly putrid may bear one bleeding in habits very 
plethoric, yet a second or third generally proves deadly. 

In the use of the lancet, the good sense and discrimination 
df the judicious practitioner can alone decide as to its pro- 
priety and application. The epidemic of one season may 
prove more inflammatory than that of another, and require 
the more liberal and repeated use of the lancet. The fever 
of the succeeding season may be more malignant and dispo- 
sed to run more speedily into the asthenic stage. In the lat- 
ter instance, blood letting must be employed at an early pe- 
riod, or else entirely omitted. The practitioner will soo» 
be enabled to judge of the propriety and importance of this 
remedy, by observing the effects produced upon the patient. 

It will readily occur to every person of reflection, that 
the violence of the fever and the strength of the circulation 
will, ceteris paribus, be in proportion to the vigor and activ- 
ity of the moving powers, as influenced by age and the sound- 
ness of the constitution ; the tension, strength and elasticity 
of the muscular fibre ; and the denseness and richness of the 
blood, as occasioned by a large proportion of gluten and red. 
globules ; under these circumstances the more liberal use of 
the lancet will be required. 



* Inquiry into the Causes? Symptoms and Cure of Put. Fever, &c p. \ 70 



Cure of Fever, 30£ 

Before concluding my observations upon blood -letting, I 
will subjoin a comprehensive view of the principal circum- 
stances which demand attention in the employment of this 
remedy, and which appear to be the following. The degree 
of excitement present. The malignity, mildness or inflam- 
matory character of the epidemic. The situation, whether 
town or country, low and marshy, or elevated and dry. The 
period of the disease. The age and constitution of the pa- 
tient ; his former habits and modes of life, as connected with 
occupation, temperance, &c. The effects of blood-letting. 
The appearance of the blood drawn. 

Upon each of these subjects it will be proper to make a 
few remarks. 

The higher the excitement the greater will be the neces- 
sity for bleeding, and the mere copious should be the evac- 
uation. 

The more malignant the epidemic, the more and sooner 
is it disposed to assume the asthenic character, and the more 
early and cautious should be the use of the lancet. 

In large towns, the disease is apt to be more malignant 
than in the country, as also in low and marshy places rather 
than in those that are dry and elevated. 

Young, robust and plethoric persons, require larger bleed- 
ings than the old, intemperate and infirm. Persons of/sed- 
entary employments require the more sparing use of the lan- 
cet than those whose exercise is more laborious and in the 
open air. If the patient has been in the habit of being often 
bled, there will also be a greater necessity for its repetition. 

In general, the earlier in the disease the more requisite 
the use of the lancet. 

The effects of the bleeding should regulate the quantity 
to be drawn, and determine the propriety of its repetition. 
If the symptoms continue unabated, it should be repeated. 
If the disease is moderated and the patient continues to im- 
prove, or symptoms of asthenia have come on, bleeding again 
is unnecessary, and would, in all probability, prove injurious. 

The appearance of the blood drawn should also regulate, 
in some degree, the extent of the evacuation. 

The appeal ances of the blood in fevers may be divided 
into three kinds. 1st, In those cases where there is much 
excitement, or what is called the inflammatory diathesis, 
the blood upon standing becomes covered with what is term- 
ed the bvffy coat, consisting of the coagulum or crassamen- 
tum, from which the red globules have separated and fallen 
to the bottom of the vessel, in consequence, it would seem, 
of the greater fluidity of the blood ? occasioned by the in- 



306 Cinre of Fevers 

creased temperature of the body* aad the accelerated ac- 
tion of the blood vessels. In general, the thicker is this 
huffy coat, and the greater its contraction, rendering its up- 
per surface concave or cup-like, the greater is the indica- 
tion for the necessity and repetition of the operation. The 
inflammatory diathesis, however, is on some occasions pres- 
ent without being indicated by the appearance of the bufify 
coat, and the latter sometimes appears in cases where the 
use of the lancet is found prejudicial. The circumstances 
favorable to the appearance of the bufly coat are, the blood 
freely flowing from a large orifice into a deep vessel, so as 
not to cool and coagulate before the red globules have time 
to subside. If, on the contrary, the blood flows slowly, and 
is received into a broad and shallow vessel, the separation 
will not take place, though the inflammatory diathesis be 
present.! 2. When the disease has been of long continu- 
ance, the blood becomes thin and watery, containing but 
few red globules. I have sometimes seen the blood so thin 
and watery in invalids who had been a long time subject to 
fever, that it would scarcely stain the patients linen. I once 
attempted to bleed a person of this description, who had ex- 
perienced a return of his fever, and whose pulse, from its 
fulness and strength, indicated the use of the lancet. His 
blood was scarcely colored, and, before half a gill had been 
taken, the sudden sinking of the pulse obliged me to stop 
the orifice. Such, also, is the appearance and condition of 
the blood in diseases of debility and in dropsy; in all of 
which blood-letting is generally improper. 3. Blood-letting 
is still more dangerous when the blood is dark colored and 
dissolved in its texture, and does not readily coagulate, as 
in scurvy and the advanced stages of the more malignant 
forms of fever. 

When the epidemic is of such a violent and malignant 
character as to destroy life in a few hours, copious bleeding 
at the commencement promises to be the only valuable and 
efficient remedy that can be resorted to. Mercury, emetics, 
cathartics and the inferior order of remedies are here inade- 
quate to cope with the gigantic strides and rapid progress of 
this formidable disorder. The enemy must be immediately 

* It is remarked by Dr. Fordyce, that the greatest degree of heat he ever 
observed in fever was 105° Fordyce on Fever, Dissert. 1st. 

t The blood when at rest in the body begins to coagulate in fifteen mi- 
nutes. Hewsori's Experimental Inquiry. Vol. I. 

Blood with the inflammatory crust does not coagulate in less than an hour 
and a half. Ibid. 

The blood is really attenuated in inflammatory disorders. The co?.gula= 
hie lymph is thin, and its disposition, to Coagulate is lessened. iHd, 



Cure of Fever* 307 

attacked in his strong hold and fortress, the vascular system; 
and this not with the cautious timidity and ill judged pru- 
dence of apprehension and distrust, but with the bold and 
vigorous hand of confidence and resolution. The following 
fact is mentioned by Dr. Sydenham in relation to the plague 
which prevailed in his time at Dunstar Castle, in Somerset- 
shire. " It happened at that time," says Dr. Sydenham, 
"that a surgeon, who had travelled much in foreign parts, 
was in the service there, and applied to the governor for 
leave to assist his fellow soldiers, who were afflicted with 
this dreadful disease, in the best manner he was able ; which 
being granted, he took so large a quantity of blood from ev- 
ery one at the beginning of the disease, and before any swel- 
ling was perceived, that they were ready to faint, and drop 
down ; for he bled them all standing and in the open air, 
and had no vessel to measure the blood, which falling upon 
the ground, the quantity each person lost could not of course 
be known. The operation being over, he ordered them to 
lie in their tents; and though he gave no kind of remedy 
after bleeding, yet of the numbers that were thus treated, 
not a single person died." In relation to this subject the 
following observations are made by Dr. Rush. " In fevers 
and other diseases which run their course in a few days or 
hours, and which threaten immediate dissolution, there can 
he no limits fixed to the quantity of blood which may be 
drawn at once, or in a short time. Botalkis drew three, 
four and five pints in a day, in such cases. Dr.Jackson drew 
fifty-six ounces of blood at one time, in a fever of great vio- 
lence and danger. This patient was instantly relieved from 
what he styled " chains and horrors." In three or four hours 
he was out of danger, and in four days, returned to his duty. 
Dr. Physic drew ninety ounces, by weight, from Dr. Dewes, 
in a sudden attack of the apoplectic state of fever, at one 
bleeding, and thereby restored him so speedily to health, 
that he was able to attend to his business in three days after- 
wards. 5 '* It is obvious that such copious bleedings are only 
admissible in the first stage of the disease. And as it is the 
nature of highly malignant fevers, when they are not sud- 
denly fatal, to run speedily into the low, chronic, typhus or 
asthenic state, blood-letting cannot be resorted to in such 
cases with safety, except at an early period of the complaint. 
There are doubtless some epidemics in which bleeding 
would be inadmissable after the first or second day, and this. 



*Rus. fog, Sc Obs. yoI. 4, p 350 Sc seqt 



SOS Cure of Feveit 

more especially when the fever is of a highly malignant char* 
acter. This was the case, we are informed by Di. Rush, in 
the yellow or bilious fever of Philadelphia in 1797. It is 
also stated by Dr. Jackson, that nineteen out of twenty of 
the soldiers whom he attended in the West Indies were cur- 
ed by copious blood-letting, provided it was performed with- 
in six hours after the attack of the fever. Beyond that pe- 
riod it mitigated its force, but seldom cured. The quantity 
of blood drawn by Dr. Jackson, in the early stage of the dis- 
ease was always from twenty to thirty ounces.* 

Though considerable discrimination and judgment are re- 
quired in the use of the lancet, there can be no doubt that 
when judiciously employed it is one of the most valuable re- 
medies that can be had recourse to in the treatment of the 
endemic fevers of the southern states. And though there 
"be cases of excitement so strongly marked as not to leave a 
shadow of doubt as to the propriety of blood- letting, yet 
there are others of langour and depression, from, ple- 
thora and an overcharged state of the blood vessels, which 
at first view would seem to forbid its use, but wherein the 
employment of this remedy would prove highly advanta- 
geous. Cases of the latter description are not easily distin- 
guished, and as it is very easy for the young and inexperien- 
ced to be deceived, they will generally find it safer in all 
doubtful cases of this nature to avoid the use of the lancet 
altogether, and to employ it in unequivocal instances of pre- 
ternatural or inflammatory excitement only ; and this more 
especially where the epidemic is of a highly malignant char- 
acter. 

It was observed by Dr. Rush, in the bilious yellow fever 
of Philadelphia in 1798. which was more fatal and malignant 
than the epidemic of 1793, that in several cases the lancet 
was forbidden at the commencement altogether, from the 
weakness and frequency of the pulse, languid eye and other 
symptoms of prostration ; but that nature performed the 
operation of bleeding on herself from the gums, on the fourth 
or fifth day, " 1 saw," says the Doctor, " several pounds of 
blood discharged on those days, and in that way with the 
happiest effects. It appeared to take place after the revi- 
val of the blood vessels from their prostrated state."f 

When bleeding is not indicated, or after its employment 
■when it is, an emetic should generally be exhibited. For 
this purpose six grains of tartarized antimony may be dis- 
solved in half a pint of warm water, and taken in divided 

*Rush Inq. & Obs. Phil. Ed. 1809, vol. 4 ; p. 35. 
t Rush Inq. Sc Obs, vol. 4, p. 78, 



Oure o/Feven 309 

doses at intervals of ten or fifteen minutes till it has opera- 
ted suiikiently. 

The use of emetics in the beginning of fever dates its 
commencement with the infancy of the healing art. Hip- 
pocrates speaks of their utility when employed at an early 
period. Sir John Pringle disapproves of them in the pro- 
gress of the disease, though, in his account of the bilious re- 
mittant fever of the Netherlands, he highly extols their effi- 
cacy when exhibited in the forming stage of the disorder ; 
and says that when a large quantity of bile was evacuated 
by an emetic, the fever was removed at once. Huxham 
placed great reliance on emetics and purgatives in the cure 
of epidemic diseases.* We are told by Dr. Rush that dur- 
ing the American war an emetic seldom failed of preventing 
an attack of the hospital fever when given in its forming 
state. t Independant, however, of any testimony in favor 
of this remedy by the physicians of other times and coun- 
tries, the general experience of the utility of emetics in the 
fevers of the southern states establishes their importance be- 
yond the power of contradiction. Some West-India writers 
are opposed to the employment of emetics altogether in the 
fevers of the tropical climates, from the danger, as they tell 
us, of exciting an irrepressible vomiting, and increasing the ir- 
ritability of the stomach : as it respects the fevers of the West 
Indies I am not authorized to give an opinion, but in relation 
to the fevers of the southern states generally, emetics are uni- 
versally admitted to be of the first importance and utility. It 
is true that emetics sometimes fail. The physician has often 
the pain of finding all his efforts unavailing; the fatal symp- 
toms, like the shades of the evening, grow thicker and more 
alarming. But, under every mode of treatment, patients will 
sometimes die, and that which is most successful alone de- 
serves the preference. I have known emetics themselves 
injurious, and si-metimes fatal. They are injurious when 
the patient is much debilitated, or when the disease shows 
an early tendency to prostration. They are prejudicial 
when 'the patient is in a fluid perspiration or in the decline 
of the paroxysm. When the pulse is frequent, small and 
weak, the countenance livid, wan and dejected; the stom- 
ach weak, sick, oppressed, with frequent retching and incli- 
nation to vomit, but discharging nothing]; emetics under 
these circumstances should be avoided as we regard the life 
and safety of the patient. 



* Huxbam on Epidemics, vol. l s 
i JUtsh lotj. k ©bs. vol. 3, p. d, 



310 Quire of Jkvtr.. 

There are probably but very few cases in which an eme- 
tic will not be found necessary and useful at the commence- 
ment of the disease. When bleeding, however, has been 
premised, and employed at the height of the paroxysm, and 
especially if the patient seems thereby to experience a de- 
gree of debility from the loss of blood, it will sometimes be 
proper to delay the exhibition of the emetic for a few hours, 
till the remission of the fever. But when the loss of blood 
lias produced but little mitigation of the symptoms, the pulse 
still rising and continuing strong and tense, the skin hot and 
dry, the emetic may be exhibited without delay. The ear- 
lier in the disease emetics are employed the more effectual 
and beneficial will be their operation, and much of that ir- 
ritability of the stomach which often accompanies bilious 
remittents, may be attributed to the neglect of employing 
emetics at the commencement of the disease : for whoever 
has witnessed the vast quantities of vitiated bile discharged 
from the stomach by the operation of an emetic, will easily 
conceive the injurious consequences that must arise from its 
being permitted to accumulate in the primae viae. 

When the fever assumes a malignant aspect, considerable 
caution is required in the use of evacuants of all kinds, and 
in none more than that of emetics, particularly the tartariz- 
ed antimony, which is also apt to act as a cathartic ; and 
when the purgative operation is considerable, we should 
dread and guard against the prostration which we have rea- 
son to apprehend. 

In all seasons when the epidemic is of a severe and ma- 
lignant nature, it will be safer to postpone the exhibition of 
the emetic till the time of the remission, should this be cal- 
culated upon with any certainty, than to employ it in the 
height of the paroxysm, and run the danger of prostration. 
If, however, from the state of the patient we have any rea- 
son to apprehend that the emetic may operate too severely, 
or produce a coldness and torpidity of the system, and should 
still determine upon its employment, as we value the life of 
the patient, we should watch its operation, and check the 
first symptoms of collapse by the exhibition of an anodyne, 
composed of thirty drops of laudanum, or when this cannot 
be retained, a grain or two of opium in a solid form. Had 
I not myself been upon the point of loosing some patients 
in the early period of my practice, from want of attention 
to the above cautions, I should not feel myself obliged to be 
go particular; but experience compels me to enjoin this 
caution upon others. The nimia diligentia Midici, of stuff- 
ing and oppressing the patient with medicine should be 



Curt of Fever, 311 

avoided. Give one remedy time to operate before another 
is employed ; if the fever has been high, and the bleeding, 
aided by the cold bath, and other febrifuges to be mention- 
ed hereafter, has succeeded in bringing about a perspiration, 
omit the emetic, even should it be indicated, till the remission 
takes place ; the system will then have recovered sufficient 
strength to endure its operation : but if given in the height 
of the paroxysm, there is reason to apprehend that the ex- 
hausting and debilitating influence of the febrile excitement 
and the operation of the emetic will produce a sudden sink- 
ing of the vital powers, wtwch will require all our care and 
attention to overcome, and may very possibly cause the 
death of the patient. 

In epidemic bilious fever attended with great malignancy, 
emetics should be given with caution or avoided altogether, 
on account of the sudden prostration and collapse, which in 
such instances succeed their operation. Thus we are in- 
formed by Dr. Rush that emetics were hurtful in the high- 
ly malignant bilious fever of Philadelphia in 1797. It is also 
stated by Dr. Pinkard that they were hurtful in the violent 
grades of the yellow fever in the West Indies. The same 
thing was observed by Dr. Jackson. It is admitted by Dr* 
Rush, however that in the second and third grades of bilous 
fever they appear not only to be safe but useful.* And the 
same author in the bilious yellow fever of 1798 and 1799, 
found the tartar emetic a most valuable remedy in cleansing 
the stomach and bowels of vitiated bile. And it was observ- 
ed by him that an emetic given in the forming stage of the 
disease, seemed to effect an immediate cure.T 

When there is much irritability of the stomach with fre- 
quent vomiting, emetics are not only unnecessary, but might 
prove highly detrimental, inasmuch as they would in such 
instances still further increase this irritation, and render the 
stomach unable to retain either fluids or solids of any dis- 
cription. It not unfrequently happens, however, that con- 
siderable sickness and irritation of the stomach exist, with 
frequent and ineffectual efforts to vomit ? merely from the 
foulness and bilous accumulations in the first passages. In 
such cases the free and plentiful operation of an emetic, as- 
sisted by the copious use of warm water or chamomile tea^ 
afford the most decided and effectual relief. 

Where we are apprehensive that the tartarized antimony 
may prove too severe in its operation, either alone or in 
combination with white vitriol, ipecacuanha may be exhibit* 

* Rush Inq. & Obs. Vol. 4. 

i Rush Inq, & Obs, Vol, 4 p, 80> 



312 Cure of Feztr* 

ed; and in delicate and irritable habits this will often b® 
more safe and proper than the emetic tartar. 

Less debilitating, though at the same time less effectual 
than either the tartarized antimony or ipecac, is white vitriol 
alone. When the object is merely to dislodge the contents 
of the stomach and procure a temporary relief, the latter 
may be advantageously employed. 

If the patient is of a weekly and delicate habit, if the dis« 
ease is advanced in its progress, if purgative medicines have 
been previously given, if the pulse is very frequent, with little 
strength and fuiness, if there is much sickness and irritabili- 
ty of stomach with frequent disposition to vomit and reject 
whatever is swallowed, it will be safer to avoid the use of the 
tartar emetic, and should we deem an emetic necessary and 
safe, from twenty to twenty-five grains of ipecac, with or 
without a few grains of white vitriol may be exhiDited. This, 
assisted in its operation by the free use of warm water? will 
cleanse the stomach sufficiently without producing that dead- 
ly sickness occasioned by the tartar emetic, or hazarding the 
event of prostration. In such cases however, it will be gen- 
erally safer to avoid the use of emetics altogether, and to 
trust to mild aperients, as cream of tartar, small doses of Ep- 
som salts and injections, to cleanse the bowels and carry off 
the redundancy of vitiated humours. Frequently the dispo- 
sition to vomit and reject every thing taken in, proceeds from 
a degree of inflamation and consequent excessive irritability 
of the stomach ; 1 have known a patient for days, to reject 
the greatest part of all fluids taken into the stomach, which 
were in a short time changed to a grass green colour, oc- 
casioned by the operation of the acid taken upon the bil- 
ious matters in the stomach ; the case was treated with mild 
aperients and injections, and the excessive irritability and 
vomiting allayed by giving, from time to time, a table spoon- 
ful of lime water and sweet milk mixed together.* 

Should not the tartarized antimony operate upon the bow- 
els after having acted as an emetic, it will be necessary to 
exhibet a cathartic. As the operation of the emetic, howev- 
er, is debilitating, and is apt to leave the patient weak and 
languid, it will often be advisable and necessary to delay the 



* Lime "water is prepared by taking fresh burnt unslacked lime or oys- 
ter shell?, pouring on hot water so as to slack and disolve a portion of the 
lime, and after standing about half an hour, the water should be poured off 
and corked up tightly in bottles, or in decanters with ground stoppers The 
proportions may be two or three ounces of quick lime to a quart of water ; 
though as the water can only take up a certain quantity it is better to have 
an excess of lime than too little. . 



Cure of FevfP. 3^3 

exhibition of the cathartic for a few hours, in order to avoid 
the danger of prostration. If the emetic, for instance, has 
been given during the paroxysm, or height of the fever, 
the purgative may be postponed until the remission, or for 
the space of five or six hours after the emetic has ceasect 
to operate. In this, however, much will depend upon the 
habit and constitution of the patient, the height and seve- 
rity of the fever, and the malignancy or mildness of the 
reigning epidemic ; bearing this in mind, that the sooner 
the bowels can be evacuated with safety, the more success- 
ful and effectual will be the practice. 

When we consider the relation and sympathy which sub- 
sist between the external and the internal surfaces of the 
body, particularly between the skin and alimentary canal, 
we must be convinced of the propriety of keeping up the 
due action of the latter in order to preserve the former in 
a perspirable condition. We observe when the skin is dry 
and constricted, that the bowels are constipated, and that 
when the latter are free and soluble, the former is moist 
and permeable to the perspirable matter. When the skin, 
however, becomes in a measure, permanently constricted, 
the excrementitious fluids which should be thrown off by 
this emunctory are determined to the intestines and excite 
them into preturnatural action ; for the purpose, it would 
seem, of eliminating the offending matter. As serving, 
therefore, to assist and anticipate the operations and efforts 
of nature, and to affect the curative indications, cathartics 
have always formed a leading and important article in the 
treatment of fever. 

It is highly important in this disease, that the bowels be 
Icept carefully free from all bilious and excrementitious ac- 
cumulations ; and this, in many instances, particularly 
when the disease assumes a malignant aspect, is not easily 
accomplished. Such is the constriction and torpidity of 
the bowels that often take place, that it is with great diffi- 
culty medicines can be brought to act upon them ; and in; 
these cases, we must have recourse to the repeated use of 
injections, composed of salts, molasses and water, with 
the addition of a little castor-oil. Should the first and se- 
cond cathartic not operate after a reasonable time, it will 
be safer to promote its action by the use of injections than 
to repeat the purgative by the mouth ; for when several 
doses are confined in the bowels at the same time, should, 
they finally be brought to operate, a hypercatharsis or over 
purgation might take place, and prostrate the patient be- 
yond the possibility of recoverv, Such accidents I have, 

■Jr ~i 



814f (hire of Tever. 

known to happen from the imprudent repitition of cathar- 
tics. In severe and malignant cases, the torpor appears 
to be attended with considerable constriction of the stom- 
ach and bowels ; the patient complaining that the substan- 
ces taken, proceed no further than the entrance of the 
stomach, and after remaining there a short time are una- 
voidably rejected. 

I have seen so many instances of this kind, that I am 
inclined to think such a constriction actually takes place. 
In these cases, neither the cathartics nor injections operate 
freely ; the stools are small in quantity, consisting princi^ 
pally of the injections, mixed with a light clay coloured, 
membranous or flakey looking substance, appearing more 
like the inner coat of the intestines than any excrementi- 
tious matter of their contents. 

There is reason to believe that on some occasions of 
obstinate constipation, there exists an intro susception 
of "some part of the intestinal canal. This circumstance 
took place in the yellow fever of Philadelphia, ' in 1805, 
and was ascertained by the dissections performed by 
Dr. Stuart and Dr. Parish. This affection was confin- 
ed to the small intestines, and was found to exist in several 
fatal cases of the disease. The cause of the intro suscep- 
tion was always from above downwards, the upper por- 
tion of the intestine being the receiver, and the lower por- 
tion the received* "Although the discovery of the ex- 
istence of the intro susceptio intestinalis" says Dr. Cald- 
well, " is interesting in itself, yet I am sorry to add, that 
it has shed no new light on the treatment of the disease. 
We are even unable to enumerate any particular set of 
symptoms, which during the life of the patient, give sat- 
isfactory evidence of the presence of this affection. It 



* Caldwell's Essay on the Yellow Fever. The following 1 remarks are 
offered by Dr. Caldwell in explanation of the manner in which this af- 
fection appears to take place: "A tonic spasm or permanent contrac- 
tion occurs in some portion of the intestine, greatly diminishing" its 
cavity and circumference, and suspending entirely its perestaltic motion. 
The portion of intestine immediately above this is free from spasm, and 
retains its perestaltic motion. Perhaps this motion is even increased by 
the action of some purgative medicine. When such a state of things 
continues for any length of time, the event likely to result from it, is 
sufficiently obvious. The upper portion of intestine, forming, by its 
natural action a fold at the place where' the permanent contraction com- 
mences, passes down over the lower portion, and receives it completely 
into its embrace. But as the natural direction of the perestaltic motioa 
is from above downwards, so long as the contraction remains permanent, 
its lower portion wJX necessarily continue to. lie invested by its upper 
one," 



Cure of Fever. ^i£ 

belongs yet to the knife of the anatomist, and to that alone, 
to discover its existence after death. Could the existence 
of the intro susceptio be clearly ascertained during life, 
perhaps bleeding the patient ad deliquium animi, would 
be the most likely way to remove the inflammation and 
spasm which constitute it." 

To this I would observe, that there is probably less dif- 
ficulty attending both the discovery and treatment of this 
affection than Dr. Caldwell seems to apprehend: and I 
think that on several occasions I have discovered its exist- 
ence by the following symptoms : more or less heat and pain 
in the bowels, obstinate constipation, which can scarcely 
be removed by the most active cathartics ; a sense of con- 
striction about the stomach, as if substances swallowed were 
unable to proceed ; uneasiness, distention and oppression 
about the epigastrium, especially upon swallowing any 
thing bulky, which is apt to bring on vomiting ; stools ve- 
ry small in quantity, ash coloured, and of a fibrous or mem- 
braneous appearance. For the removal of these symp- 
toms, I have found nothing so effectual as blistering the 
epigastrium ; warm fomentations ; when the pain is consid- 
erable anodyne enemata of laudanum and warm water ; 
the frequent use of injections composed of warm water, 
molasses, and a little salt or castor-oil : these, as they 
excite the perestaltic motion of the large intestines from, 
below upwards, produce that kind of action which is best 
calculated to remove the intro susceptio. 

The importance of evacuations by the bowels, will be 
the more obvious when it is considered what offensive and 
noxious accumulations are disposed to take place in them, 
which, by being in part absorbed from the intestines and 
re-conveyed into the mass of circulating fluids must, una- 
voidably, aggravate the prevailing symptoms. As the 
matter contained in the bowels in bilous fever is of the 
most noxious and excrementitious quality, drained off and 
secerned from the general circulation, so, where this is suf- 
fered to accumulate in any considerable quantity, it is in 
part taken up by the lymphatics, and by being generally 
diffused, adds to the contamination of the system ; bring- 
ing on the typhoid symptoms at an early period, and caus- 
ing a yellow suffusion on the surface of the body. But if 
the bowels are kept free from such bilious accumulations, 
the yellowness of the body is, in a considerable degree, 
prevented ; otherwise tremors, jerkings, and subsultus ten- 
fliuum are apt to come on early, and the patient is either 
lurried off by violent convyjsions, or by the move conceal* 



fgfg Cure of Fever. 

ed malignancy of the disorder. Though a yellowness of 
the body is not common in this disease, and although it 
sometimes appears in cases that are not remarkably malig- 
nant, yet, generally speaking, it marks a disease of consid- 
erable severity ; and where this yellowness is interspersed 
•with livid or purple spots, or with streaks and blotches, 
we may with considerable certainty, calculate upon a fatal 
termination, Against this, therefore, we should be parti- 
cularly careful to guard by the early use of cathartics and 
injections. Nor should we, on all occasions, be deterred 
from their employment on account of the frequency, or 
the weakness and smallness of the pulse, for these symp- 
toms of oppression often disappear upon the operation of 
laxatives or injections. Besides, this weakness, smallness 
and thread-like feeling of the pulse often come on at an 
early stage of the disease, and evidently arise from an op- 
pressive accumulation of bilious and excrementitions mat- 
ters in the bowels, for upon procuring a free evacuation, 
the pulse becomes less frequent and more full. Many 
practitioners, by attending chiefly to the state of the pulse, 
are apt to overlook the principal circumstance ; and when 
the circulation begins to flag, they fly to cordial and tonic 
remedies, without reflecting upon the necessity of correct- 
ing that condition of the body by which this languor of 
the heart and arteries is produced ; supposing the human 
machine to be acted upon like a weather-gage, or by the 
simple addition and subtraction of stimulus : whereas, in 
fever, mere debility forms but a small part of the disease : 
it is here the vitiated condition of the fluids and of the 
body generally, that we have to do with, and the support- 
ing the strength of the system is only a secondary consid- 
eration, as enabling us to combat more effectually with the 
lurking mischief. Strmulents are here of little service, 
■until the matter by which the vital functions are oppressed 
and paralized, is removed. Bark, wine and cordials, if re- 
quired, may then be employed with advantage. 

It would appear that the beneficial and cooling effects of 
perspiration do not consist merely in the evaporation 
from the surface thereby occasioned, but in the excretion 
of irritating and offending matters from the circulating 
fluids. We often observe the same effect from the opera- 
tion of a brisk cathartic in the paroxysm of fever, as takes 
place from the flow of perspiration ; and we hence con- 
clude that independent of the mere removal of fecal mat- 
ter from the bowels, cathartics possess a more extensive 
efficacy in drawing off the morbid and excrementitiotts' 



■Qure of Fever * 317 

fluids of the body, and of preventing the absorption of vi* 
tiated secretions from the cavity of the intestines. 

Though it is essential to preserve the bowels free from 
offensive accumulations, yet in the advanced stage of the 
disease, caution must be exercised in the exhibition of ac- 
tive cathartics. If there is any considerable degree of 
debility present, or if from the previous intemperate habits 
of the patient, we have reason to apprehend the early ap- 
pearance of debility and prostration, we should be econo- 
mical of the strength of the diseased, and should use the 
mildest laxatives, as senna and manna, or very small doses 
of castor-oil, and trust more to the use of injections in 
cleansing the bowels than to the employment of purga- 
tives given by the mouth. I have known a moderate ca- 
thartic given in the advanced stage of fever to sink the 
patient beyond the power of recovery. 

In deciding in doubtful cases upon the propriety or im- 
propriety of exhibiting a cathartic, it is not sufficient that 
we take into consideration the strength or weakness of the 
pulse, but we should regard, more especially, the general 
habit, and the vigor or debility of the animal functions. — , 
For the action of the heart and arteries may appear strong, 
when at the same time there is great general debility, and 
to exhibit an active cathartic under these circumstances, 
would occasion prostration, and endanger the life of the 
patient. The circumstances which govern the employment 
of blood-letting, should, in some degree regulate the use 
of cathartics. Where the patient is much debilitated, 
none but the mildest laxatives, or injections are admissi- 
ble ; and in the advanced stage of the disease we should 
be particularly cautious against the employment of active, 
remedies. 

With respect to the medicines to be employed as cathar- 
tics and laxatives, there is a considerable choice and vari- 
ety, according to the circumstances of the patient and the 
disease. Calomel. and jalap is an old and favorite medi- 
cine with many practitioners, and its use is sanctioned by 
the precept and example of Dr. Rush ; who in the yellow 
or bilious fever of Philadelphia, 1T93, and in those of sub- 
sequent years, considered it almost a specific, and next to 
the lancet ; or the second remedy in the catalogue of the 
curative means which he employed. It was not, however 
one or two doses that he found sufficient to answer his ob- 
ject. There is but little objection to calomel and jalap as 
a purge, provided the patient's stomach will retain them. 
Not unfrequently, however, they nausseate to such a de- 



348 Cure of Fever. 

gree as to bring on a vomiting, by which they are entirely 
rejected. On such occasions I have often succeeded by 
making them into pills, directing two or three to be swallow- 
ed every half hour until the necessary quantity has been 
taken. From ten to fifteen grains of calomel with from 
twenty to thirty of jalap, according to the habit and con- 
stitution of the patient, may be given at a dose. But the 
medicine, which on many occasions, I prefer to the above, 
is calomel and castor-oil. The calomel should be given 
first by itself, mixed up in a spoon with syrup or molasses, 
and the oil immediately, or in a few minutes afterwards. 
On several occasions I have witnessed the superior efficacy 
of this purge to that of calomel and jalap ; it is less nau- 
seating to the stomach, is more free and copious in its op- 
eration, and is not attended with that pain and griping 
which frequently accompany the operation of calomel and 
jalap. Cream of tartar and jalap is also an excellent pur- 
gative on many occasions, and it is generally quicker in its 
operation than any other cathartic. About twenty grains 
of jalap and two or three tea-spoonfuls of cream of tartar 
may be given at a dose, and repeated, should the first not 
operate sufficiently. 

During the operation of these purgatives, the patient 
should drink freely of thin warm gruel or weak tea. 

Sometimes the irritability of the stomach is such as to 
forbid and prevent the exhibition of all bulky articles by 
the mouth. In such cases, in order to keep up the action 
of the bowels, we must have recourse to calomel, given 
either simply with syrup, or in combination with some 
aromatic ; and its operation may be assisted by the use of 
injections. In general, calomel alone, is not sufficiently 
active to operate upon the bowels ; and as cream of tartar 
is less nauseating than almost any other medicine, I have 
frequently prescribed it freely to assist the operation of 
calomel : besides, independent of any cathartic operation 
which cream of tartar may exert, in cases where the ex- 
citement or fever is considerable, it acts as an excellent 
febrifuge. 

The high commendation bestowed by Dr. Hamilton on 
the use of purgative medicines in typhus fever, is calcu- 
lated in many instances to be productive of serious and 
fatal consequences ; and though it is of importance that 
the bowels, in all stages of the disease, be preserved free 
from morbid accumulations, and though the free and libe- 
ral employment of cathartics is proper and necessary dur- 
ing the .early stage of bilious fever, yet when the patient 



Cure o/Fevct, 319 

has become affected with the prostration of typhus or as- 
thenia, the exhibition of an active cathartic would prove 
speedily fatal. I speak from experience, having more than 
once had occasion to regret the employment of a purga- 
tive under these circumstances in a torpid and constipated 
state of the bowels, and where the symptoms previously 
had not been alarming ; yet two or three motions by stool 
has sunk the pulse and vital powers beyond the possibility 
of restoration. The more malignant the disease, the more 
liable is this to happen, and it is always safer to trust to 
gentle laxatives and the use of injections to preserve the 
bowels free from accumulations in the latter stages of the 
disease, than to hazard the debilitating operation of an ac- 
tive cathartic. 

Dr. Rush, Dr. Chisholm, and several other modern phy- 
sicians, besides giving calomel as a purgative, have recom- 
mended and exhibited it in large quantities in bilious ma- 
lignant fevers, with a view of exciting salivation. There 
can be no doubt that in some cases, calomel may prove a 
useful remedy in the endemic fever of hot climates ; but 
in its exhibition there are several circumstances to be kept 
in view ; and to employ it merely with the design of pro- 
ducing salivation is a practice altogether empirical. 

Most physicians who have witnessed much of the mer- 
curial treatment must have observed cases wherein a sali- 
vation was effected, and which, notwithstanding, termina- 
ted fatally ; others, again, where no salivation could be 
produced by the most liberal and excessive exhibition of 
this medicine, and yet the patients have recovered ,• and 
numerous other instances they have remarked in which 
the gums and mouth did not become affected by the mer- 
cury until after a complete crisis of the disease, and every 
symptom of the fever had disappeared. The truth is, that 
when the fever is slight, the skin soft and moist, and the 
pulse yielding and free from tension, it is not in general 
difficult to excite a salivation, and as this takes place the 
fever subsides ; but it still remains a question whether in 
those instances the salivation is the cause or effect of the 
favorable change that has taken place ; for when high in- 
flammatory symptoms prevail, or when those of a typhoid 
character make their appearance, with a languid circula- 
tion, and a cool, dry and withered skin, it is either impos- 
sible to produce a salivation, or when affected, it affords 
no relief; the patient perhaps dies, or a slow and linger- 
ing recovery confines him for a long time to a v sick bed. 

This medicine was £rst brought watp popular feshion as 



320- Lure of Fever, 

a sovereign remedy in fever, by Dr. Clark, and trie practice 
was afterwards improved and made more general, by the 
extravagant encomiums lavished in praise of its efficacy by 
Dr. Chisholm. From one to eleven ounces of calomel 
were given by Dr. Chisholm to patients in the feVer of 
Granada, in 1793. — But the eulogiums of Dr. Chisholm in 
favor of excessive quantities of mercury in the Granada 
fever, come to us very much qualified by Dr. Stuart, who 
practised in the same disease. He informs us that from 
the strong recommendations of Dr. Chisholm, he was in- 
duced to give calomel a trial. "Sanguine in the expecta- 
tion of benefit therefrom, but I am sorry to add that it did 
not prove an effectual remedy in my hands. "* 

When calomel is prescribed and exhibited in the gener- 
vl manner recommended by the sticklers for this medicine, 
without discrimination of the character and stage of the 
fever, or the age and habit of the patient, its injurious con- 
sequences cannot fail to predominate over its beneficial ef- 
fects. The object of Dr. Chisholm was to produce a sali- 
vation, for which purpose he was some times under the 
necessity of exhibiting from three to four and even eleven 
hundred grains of xalornel. I have above pointed out the 
circumstances of the patient as favorable or otherwise to 
the operation of mercury ; and it must evidently occur to 
the reflection of every prudent and judicious practitioner, 
that when such immense quantities are required to pro- 
duce salivation, there must be a condition of the system 
extremely unfavorable to the action of this medicine, and 
a state of the disease, which instead of being benefited, will 
be aggravated by it. The sad consequences of such inju- 
dicious practice were strikingly exemplified at New-Or- 
leans, in the year 1312. Three companies of the first re- 
giment of artillery were then stationed at the barracks in 
tMt city, of whom a great portion died with the bilious 
('ever, (yellow fever if you please) and from the cvects of 
-lercury-. According to the fashion of the times they 
were treated upon the mercurial plan, and with as much 
liberality of practice as even Dr. Chisholm himself could 
have desired: this Sampson of the Materia Jlfedicawa.snot 
prescribed by the weight and measurement of grains, but 
was given to the patient in a cup, and he was directed to 
eat it by the spoonful. The consequences may be readily 
imagined : few survived to tell the mournful story. It 
v; . said that mercury was not so effectual this season ae 

taSfeatet uno. T.-ancIs' Amd. Me£. & PhtL Beg"- Vol. HI. p. 199. 



Cure of Fever. ' S21 

it had been on many other occasions : I should rather say 
that in some instances it had not proved so destructive. 

By writers on the Materia Medica, mercury is classed 
and considered as a stimulant or tonic, general and per- 
manent in its operation and effects, and promoting at the 
same time all the excretions of the body. 

According to my own observation, I should say that 
such was its operation under certain circumstances of the 
constitution only.^ Mercury, to be useful, should be em- 
ployed in the early stage of fever ; for if it be deferred 
until a late period of the disease, or until asthenic symp- 
toms have made their appearance, its exhibition will be of 
doubtful utility, and will be very apt to prove highly inju- 
rious, by increasing the prostration and aggravating the 
disorder. This fact should be well remembered, as the 
result of much experience. It is well known that the first 
operation of calomel is to produce a greater or less degree 
of nausea, and a sensation of general lassitude, debility 
and depression, with a frequent, small and weak pulses- 
Such being its effects, we must be aware that it cannot fail 
to prove prejudicial in all cases of fever where there is 
much prostration and debility, attended with a weak and 
languid circulation, and a cool, dry and unperspirable skin* 
This is an important fact to be constantly kept in view in. 
the employment of calomel, for if exhibited under the cir- 
cumstances here pointed out, the practice must prove dan- 
gerous or fatal to the patient. If his situation is such as 
to require stimulents, calomel, even admitting it to possess 
this property, must be too slow and sluggish in its opera- 
tion to be of any service ; and if its first and most obvious 
effect is to debilitate, it must prove directly prejudicial. 

Except, therefore, merely as a means of opening the 
bowels, mercury should never be exhibited after typhoid 
or asthenic symptoms have made their appearance, and un= 



* * 'Respectable physicians have asserted," says Dr. Currie s "that when, 
salivation could be produced in the yellow fever, recovery was almost 
always the consequence. It may be said, perhaps, that where the pow- 
er of the absorbents remains, and there is time for a salivation to be ef- 
fected, the disease has been generally of a mild nature, and the recove- 
ry more probable from the first. But I may also remark, what has not 
before been observed, that salivation is accompanied by a more profuse 
perspiration from the surface, a circumstance which may diminish the 
febril heat and irritation."— Currie on Water, p. 384. 

It was observed by Dr. Thomas Clark that in the East Indies, mercu- 
ry, whether used externally or internally, almost always occasions an in- 
creased secretion of bile, notwithstanding 1 a copious perspiration should 
have been kept up at the same time ,— Clark on the Nature & Cure of Fever . 
Q.2 



322 Cure of Fever. 

der these circumstances injections will be more proper 
than the exhibition of purgatives or laxatives by the mouth 

There is a prostration of the system and a feebleness oi 
the circulation which frequently take place in the early 
stage of fever, differing materially from the asthenia and 
exhaustion of typhus. In the former, the intellect is some 
times confused, and the patient affected with a degree of 
stupor, but there is less of that lethargic and unnatural 
slumber which takes place in the latter, and the counten- 
ance is, in a great measure, free from that fallen hypocra- 
tic expression which generallv characterises the typhoid 
stage of the disease. The latter is the result of the pro- 
gressing malignancy of the disorder ; the former may take 
place from any sudden evacuation, but more frequently 
from oppressive and offensive accumulations in the stomach 
and bowels. This is a distinction of some importance in 
practice ; for when this apparent debility of the system, 
and weakness and smallness of the pulse merely proceed 
from anxiety and oppression, occasioned by the foul state 
of the first passages, a moderate dose of calomel, aided in 
its operation by injections, will prove serviceable. With 
the same view, I have also sometimes employed emetics 
of ipecac, or white vitriol, with the most happy result. 

There is still a condition of the system unfavorable to 
the employment of mercury, which remains to be noticed. 
When the fever is considerable, the skin warmer than nat- 
ural, but dry, shrunk, and impervious to the perspiration, 
and the pulse hard and wiery, it is difficult to excite a sali- 
vation ; and calomel, in such cases, is found to aggravate 
the symptoms. If, however, it is still persevered in, and 
the patient is .able to endure the treatment, the character 
of the disease becomes changed, and a true mercurial fe- 
ver is produced, with a small, hard, frequent, and wiery 
pulse, a dry and parched state of the skin, a swollen, dry 
and inflamed state of the fauces, exuding a disagreeable 
slimy mucus, but no salivation is produced. The physi- 
cian, ignorant of the cause of the obstinacy and continu- 
ance of the fever, pushes the mercury to the extreme, and 
by persisting, kills his patient. 

Where a large quantity of mercury has been given in 
the course of the fevifr without showing its effects upon 
the salivarv glands during the continuance of the disease, 
it often happens that a violent ptyalism breaks out upon 
the subsidence of the fever, which proves more tedious 
and distressing than the original disease. This salivation 
is sometimes attended with p;reat swelling of the face. 



Cure of Fever. 323 

throat, tongue, and salivary glands ; ulcerations of the 
mouth, fauces, and inside of the cheeks ; erosions of the 
blood-vessels, producing hsemorrhagie, and ending in some 
instances, by extensive slaughings, mortification and death. 
Sometimes the patient survives with the loss of the uvu- 
la, or of a portion of the inside of the lips and cheeks* 
which, in healing, become unites to the gums, impeding 
the motion of the jaws, and rendering speech and masti- 
cation difficult. To all which, may be added, the loss of 
teeth, from the ulceration, decaying and sloughing of the 
gums, not to mention the injury done to the constitution^ 
To allay and subdue this violent salivation, the bowels 
should be kept freely open by the daily use of sulphur, in 
the quantity of a tea-spoonful two or three times a day ; 
the mouth should be washed frequently with a solution of 
alum, to which Peruvian or oak bark may be added, or 
should the mouth be very tender, sage tea and honey ; and 
the internal inflammation of the mquth or throat may be 
allayed by the external application of blistering plasters . 
All cold drinks and exposure to the cold air, and bathing 
with cold water should be avoided during the continuance 
of the salivation. 

It is well known that in scurvy the smallest quantity of 
calomel produces violent salivation, and that its repeated 
exhibition soon destroys the patient. Persons of scorbu= 
tic habits, as indicated by offensive breath, spongy, livid 
gums and rotten teeth, from which the gums have partial- 
ly separated and decayed, are likewise easily thrown into 
a salivation ; and to such, mercury should be cautiously 
exhibited in fever. 

I have sometimes been induced to believe that calomel 
has the property of altering the colour and appearance of 
the evacuations from the bowels ; giving them a dark, 
shining and bilious appearance, when at the same time, 
there might not have been any redundancy of bile in the 
system. This I am the more inclined to believe from ob- 
serving that the discharges produced by other purgatives, 
though free and copious, did not exhibit the same appear- 

* Matthias, speaking 1 of the effects of mercury in the syphilis, says, 
•' Sometimes a fever ensues, with inflammatory rheumatic swellings of 
the face and extremities ; at others, it produces local inflammations, 
supurations, ulcerations, and even gangrene, especially about the cheeks 
and fauces : the intestines are very easily affected by it, and then vio- 
lent fluxes, with great pain and discharges of blood ensue. Mercury 
appears to destroy the energy of the nervous system, producing weak- 
ness, tremors, pajsjss, epilepsy and cania l ---' l Jfc^W8 on the Msrwwl 
Disease, p, 18, 



324 Cure of Fever. 

ance, unless there was at the same time a morbid redun- 
dancy of excrementitious matters in the bowels. A ques- 
tion may arise, however, whether this property of calomel 
is not owing to its greater power in acting upon the biliary 
organs, and thereby emulging more effectually the vitiated 
secretions. 

Though It cannot admit of a question that the injudi- 
cious use of calomel has been productive of great and se- 
rious injury, yet the authority and observation of many 
respectable physicians, both in America and the West In- 
dies, stands in vindication of its utility when employed 
with the view, and to the extent of producing salivation. 
By as many, and equally respectable physicians., it is en- 
tirely rejected in billious fevers. The impartiality of jus- 
tice and the truth of experience would incline us to occu- 
py the middle ground : carefully avoiding that error and 
empiricism in physic which would inculcate the belief 
that mercury is a specific in endemic fever ; at the same 
time bearing in mind the limited sphere of its utility and 
safety, and the cautions already enjoined. When none of 
the circumstances pointed out forbid its use, it may be 
given as an apperient and diaphoretic in combination with 
nitre and antimonial powder. The proportions I make use 
of are from one to three grains of calomel, three of anti- 
inonial powder and eight or ten of pulverised nitre every 
three hours. When the fever is disposed to assume a low, 
nervous or typhoid character, from three to five grains of 
camphor may be added to each powder. 

The next remedy in point of importance, is the cold bath. 
The ancients were acquainted with the use of cold water, 
both as an external and internal remedy in fever. Like 
many valuable discoveries and improvements, however, it 
remained for a long time neglected, until revived in later 
times, it was employed as a modern remedy in an epidem- 
ic fever at Breslaw in Selicia about the year 1737. De 
Hahn relied upon the use of the external application of 
cold water in the treatment of this disease, and its supe- 
rior success was manifest when compared with the prac- 
tice of other physicians who did not employ it. From 
Breslaw the practice was introduced into some of the 
neighboring countries. From some cause, however, pro- 
bably from the circumstances under which it should be 
used not having been well understood, cold bathing never 
became general until the attention of physicians was again 
directed to the subject by some West India practitioners. 

We are informed by Savary, i n his letters on Egypt, that 



Cure of Fever. 325 

the inhabitants of the Said, cure the burning fevers to 
which they are subject, by drinking freely of cold water, 
and bathing in the Nile. 

It is related by Morandi, a Venetian physician, that sev- 
eral sailors at Constantinople who were seized with the 
plague, (or epidemic fever) in a state of derangement, threw 
themselves into the sea, from which being rescued, they 
were speedily cured. 

Similar instances of success are mentioned by Desge- 
nettes as happening to some of the French soldiers, from 
plunging into the Nile in Egypt, and into the sea at the 
siege of Jaffa. 

As animal nature when left to itself, generally has re- 
course to those means that are most conducive to its com- 
fort and agreeable to its feelings, and considering the in- 
stinctive cravings of febrile patients for cool drinks and 
cool air, it is rather a matter of astonishment that a reme- 
dy so well adapted to the feelings and situation of persons 
laboring under fever, should have been so long neglected ; 
nor should we be surprised that untutored savages in this 
particular should possess an advantage over the philoso- 
phical sceptics of civilized nations. We are accordingly 
informed by Mr. Bruce in his travels, that the inhabitants 
of the island of Massuah cure the most violent bilious 
fevers by suffering the body to lie for some time in a bed 
of cold water. 

Dr. Wright, who had practised for several years in the 
island of Jamaica, published 1786 an account of the suc- 
cessful employment of the cold bath in several cases of 
fever. To the last mentioned physician, succeeded several 
other European and West India practitioners, as Jackson, 
Gregory, M'Lean, Gerard, Brandreth, who illustrated by 
their success the superior advantages of this remedy. In 
Europe, Dr. Currie of Liverpool, has made extensive and 
accurate observations on the subject, and has much im- 
proved and systematised the practice. But as the use of 
cold water, both externally and internally in fever, is now 
admitted as a general remedy in medicine, it is unneces- 
sary to enumerate the various authors who have since 
written in support of its utility. 

The cold bath is at all times proper when the skin is 
hot and dry, whether at the commencement or in the pro- 
gress of the disease. The colder the water, the more ef- 
fectually it answers the object. And in order to reduce 
its temperature below the natural standard of tVe well or 
fountain, a portion of common salt may be dissolved in i ; 



326 5 Cure of Fever. 

immediately before it is poured upon the patient ; this will 
also render a less quantity necessary. In general, two 
common water bucket fulls at a time are sufficient.^ The 
most proper period for employing the cold bath is when 
the hot stage is at its height ; though it cannot be impro- 
per any time when the skin is dry and the temperature of 
the whole body is above the natural and healthy standard. 
After the bath, the patient is wiped dry, put in bed and 
covered up lightly. Should the heat again become exces- 
sive without the appearance of perspiration, the cold bath 
should be repeated, and so on, should it be necessary, for 
several times successively in the course of the paroxysm, 
until the sweat breaks out and the fever subsides. 

Sometimes the cold bath will not avail until after vene- 
section ; and in general, whenever the excitement is suffi- 
cient to require the cold bath, blood-letting will be previ- 
ously necessary. By the aid of these two powerful reme- 
dies the most violent and ardent fever may in general be 
subdued and brought to a remission. I have known the 
cold bath repeated several times in the course of a few 
hours without procuring more than a temporary abatement 
of the fever, which yielded immediately upon the employ- 
ment of the cold affusion after copious venesection. The 
most obvious effect of the cold bath is to reduce the tem- 
perature of the surface, to diminish the force and frequen- 
cy of the pulse, soften and relax the skin, and to bring 
about a flow of perspiration. In the majority of cases, a 
flow of sweat follows its employment, although I have 
known it highly serviceable when no sensible perspiration 
was produced by it. Perspiration, however, commonly 
takes place after two or three repititions, and in many 
cases, once is sufficient to relieve the paroxysm and pro- 
duce a remission of the fever. 

Some attention should he paid to the manner of employ- 
ing the cold bath, and to the quantity of water affused in 
order to ensure its good effects. If the patient is much 
fatigued by the removal and exertion, or if too large a 
quantity is applied at once and for too long a time, but 
little benefit will be derived to the patient, and danger is 
incurred of converting a valuable remedy into an injurious 
agent. When the temperature of the body is much re- 

* In order to ivoid the fatigue of removal, I generally direct a large 
wash-tub to be brought to the bed side of the patient, and placing a 
narrow str : r of board across it, he is seated upon it so as to let the wa- 
ter run in the tub : the water is poured gradually upon big head and 

shoulders so as to wet the wHolv bod^. 



Cure of Fever, 32,' 

duced below the natural standard by the too copious affu- 
sion, or too long continued application of cold water, the re- 
action is slow and difficult. It is to the sudden impres- 
sion upon the system and the change in the state of the 
cutaneous vessels produced by the cold bath that its bene- 
fit is to be ascribed. , It has been previously observed that 
sweat is the most natural and ordinary crisis of fever ; and 
as the cold bath seems chiefly to owe its beneficial effects 
to its power in promoting this salutary discharge, the pre- 
sumption is that the beneficial operation of this remedy 
consists in producing a state of the surface and general 
system favorable to the flow of perspiration. 

Cold bathing is more sudden and powerful in its effects 
than any other remedy in the whole circle of medical 
prescription. Let a person be burning with never so vio-^ 
lent a fever, with a skin hot and parched and almost into-' 
lerable to the touch, a pulse, frequent, strong and hard, 
the heart throbbing and palpitating with such violence as 
to jar and agitate the body, the eyes blood-shot and wa- 
tery, and a violent pain in the head — the affusion of one 
or two buckets of cold water will instantly mitigate these 
symptoms ; the heat will be reduced to, or even below the 
natural standard ; the pulse will be rendered slower and 
softer ; the pain in the head will be diminished or entirely 
relieved, and the patient will express his satisfaction that 
he feels infinitely better. Though the cold bath relieves 
the patient, subdues the morbid temperature, and reduces 
the pulse in frequency and force, yet it does not put an 
immediate stop to the progress of the paroxysm. In a 
short time after its use the fever will be found to rise again, 
and if a perspiration does not soon appear, the heat and 
febrile action will resume their former violence. The uti- 
lity of the cold bath seems to consist in producing that state 
of the surface and of the general system favorable to the 
appearance of the perspiration, and to the solution or crisis 
of the paroxysm, which is never the work of a few moments, 
but the result of time and the progressive developement of 
the symptoms. The operation and effects of cold bathing 
are the same in every form of the endemic fever, whether 
of the intermitting, the remitting, or continued type ; that 
is, it procures a tempory abatement of the symptoms, and 
facilitates and expedites the solution of the fever. These, 
remarks are made in contradiction to the position of Dr. 
Giannini, an Italian physician, who affirms that the cold 
bath, by way of immersion of the body in cold water, "put? 
an immedi-ate stop to the paroxysm,, when employed in th ; 



328 Cure of Fever. 

hot stage of an intermittent," than which nothing is more 
erroneous and untrue. 

From the property which cold bathing possesses of di- 
minishing the temperature of the body and of lessening 
the force and activity of the circulation, it is evident that it 
is inadmissible in those cases where the heat of the body is 
below or only equal to the natural standard of health, and 
where the circulation is weak and languid ; and that it is 
unsafe in cases of prostration or in the latter stages of ty- 
phus. In such cases permanent debility and even death 
might be induced by it, on account of the system being too 
much debilitated to possess the power of reaction. 

In some instances where the cold affusion affords but a 
temporary mitigation of the symptoms, the heat and rest- 
lessness returning, without the appearance of perspiration, 
soon after the patien: is lain in bed, or when he complains 
of faintness and inability to sit up or be moved, the heat at 
the same time being considerable, I have found in such 
cases the best effects from wrapping the whole body in one 
or two linen sheets, wet with cold vinegar and water, re- 
moving them from time to time as they become hot and dry. 
In debilitated patients, also, who could not well endure the 
fatigue of sitting up to receive the cold bath, I have direct- 
ed them to be laid upon the floor, or upon a naked cot, and 
the cold water to be poured over them gradually until the 
temperature and excitement were sufficiently reduced. 

It is not necessary, however, in order to ensure the good 
effects of this remedy that the temperature of the body 
should be much increased, and in many cases of slow and 
lingering fever, in which there is never any distinct remis- 
sion, although the fever never rises high, the affusion of 
water of about the temperature of 75° I have found an ad- 
mirable remedy in bringing about a complete intermission, 
so as to admit of giving the bark with safety and success. 

As the benefit of the cold bath seems to consist in reduc- 
ing the temperature of the body and in producing perspira- 
tion, it is obviously unnecessary whenever the skin is soft 
and perspirable, and much less when the body is wet with 
sweat. Perspiration itself is a cooling process, and more- 
over, an outlet to the morbid matter. Cold bathing, there- 
fore, when the patient is in a profuse perspiration, cannot fail 
to prove prejudicial, though the temperature of the body 
at the time of employing it may be considerably above the 
healthy standard. Besides, the heat of the body is often 
kept up in such cases by the injudicious treatment of the 
friends snd attendants, who from a mistaken fear of the pa- 



Cure of Fever, 329 

tient/s taking cold, or suffering a check to the perspiration, 
oppress him with the, confinement of closed doors and win- 
dows, and load him with bed clothes ; and upon remo\ing 
the load of clothes and permitting him to breathe the free 
air, the heat speedily sinks to its proper temperature : cold 
bathing under such circumstances would give a sudden 
check to the perspiration, and produce an alarming and dan- 
gerous diminution of the animal heat. 

When there are symptoms of congestion or inflammation 
of any of the internal viscera, as of the lungs, liver, &c. 
an objection may arise as to the propriety of the cold bath 
and when there is any considerable inflammation of some 
organ present, it would not be advisable to ha v e recourse 
to this remedy. But it is not uncommon in the endemic 
fevers of warm climates for the patient to be affected with 
more or less cough during the cold as well as at the com- 
mencement of the hot stage ; but unless this is also attend- 
ed with a fixed pain of considerable violence it is to be re- 
garded merely as a symptom of irritation, and affords no 
objection to the employment of the cold bath. 

In the use of this remedy, attention should be paid to 
the state and character of the fever, and to the symptoms 
of local congestion or inflammation, if the disease is ad- 
vanced in its progress ; if the patient complains of great 
internal distress, with pain in the chest, stomach or bowels ; 
if he is predisposed to consumption ; or of a slender, fee- 
ble and delicate habit, the cold bath should be avoided ; for, 
though it may procure a temporary relief under such cir- 
cumstances, there will be reason to apprehend a permanent 
injury, which may result in the death of the patient. These 
remarks are not made upon speculative inferences, but are 
the result of observation. I know a contrary doctrine has 
been lately taught, but those who embrace it in theory 
should be careful how they carry it into practice ; and they 
should bear in mind that the fine spun hypotheses of the 
closet, which attempt to apply the supposed modus operan- 
di of every remedy to their explanation and support, will 
often be found defective and dangerous at the bed side of 
the patient. From the operation of remedies of tried and 
acknowledged utility, we may reason upon their operation. 
But to enforce the application of a doubtful or untried rem- 
edy, by arguments drawn from mere speculation and hy- 
pothesis, is inverting the order prescribed by procedence 
and discretion. 

The effect of cold bathing may be increased by placing 
the lower extremetees of the patient in a tub of warm water, 



320 Cure offovfr. 

and whilst in this situation dashing cold water upon the su- 
perior parts of the body. 

When the fever is high, I always resort to bleeding pre- 
viously to having recourse to the cold bath; and if by the 
use of the former a free and general perspiration is promo- 
ted, the cold affusion is postponed till the rise of the fever 
and the dryness of the skin render it necessary. 

An objection might arise to the use of the cold bath in 
cases where the patient has recently taken calomel; but this 
objection is entirely groundless. I have on many occasions 
employed the cold bath on patients to whom calomel had 
been daily exhibited, without having experienced any inju- 
ry, but who, on the contrary, were as much benefitted by 
the cold affusion as those to whom no mercury had been 
given. It is well known that a check given to the perspir- 
ation, or the taking cold, as it is called, in persons who 
have been taking mercury determines the action of this med- 
icine to the salivary glands, and occasions a profuse and 
sometimes dangerous salivation: but it has been previous- 
ly observed that the operation of the cold bath is to pro- 
duce perspiration, and that no danger, therefore, can be ap- 
prehended from it, when employed with the observance of 
the cautions before pointed out. # 



* For further particulars with regard to cold bathing- the reader is re- 
ferred to the communications of Dr. Wright in the London Med. Jour, 
and to the 7th Vol. Medical Facts and Observations; Currie's Medical 
reports on the effects of water cold and warm; Dr. O'Leary's communi- 
cations in testimony of the good effects of cold water in typhus iderodes, 
3Lond. Med. Jour. Vol. xvi p. 490, and the communications of Dr. Sel- 
don and Dr. Whitehead of Norfolk, Med. & Phys. Jour. Vol. x p. 266. 
The drinking of cold water, says Dr. Currie, "in fevers is regulated by 
the same circumstances as the affusion." He thinks that the fatal effects 
of drinking cold water after severe exercise, is owing to the body being 
already in a cooling" state from the perspiration and fatigue that have 
been induced; and that if taken while the body is very warm, and before 
it is in a sweating state, no ill effects would happen, contrary to the doc- 
trine of Dr. Rush. This opinion is probably erroneous, and the manner 
in which I would account for the fatal consequences is as follows. In 
the first place the whole body has become excessively overheated by 
exercise, — secondly, as the effect of this exercise there has been pro- 
duced a greater or less degree of exhaustion and debility, — thirdly in 
consequence of this exhaustion and debility, the body is less able to re- 
sist hurtful impressions from external causes, or to exert a vigorous re- 
action, — fourthly, the extensive sympathy of the stomach with every part 
of the body, and particularly the heart and arterial system, for we al- 
ways find a sick and weak stomach attended with a weak and frequent 
pulse, — fifthly, the sudden impression of the cold water upon the heat- 
ed and debilitated stomach, reducing its temperature and destroying its 
tone before it has power to adapt itself to the sudden change and resist 
the impression, — sixthly, this attony in the stomach communicates it- 
self to the heart and puts a sudden stop, or gives a check to the circu- 



Cure of Fever. ,33 1. 

"When as is oftemthe case, the heat is unequally distrib- 
uted, being on some occasions more intense at the pit of the 
stomach, on others in the head and extremities, the appli- 
cation to these parts of cloths wet with cold vinegar and 
water will be found both soothing and beneficial; it allays 
the distressing sensation of heat in these parts, renders the 
temperature more equible tends to subdue the paroxysm^, 
to produce perspiration, and to procure a remission or in-i 
termission of the fever. When there is a burning heat at 
the stomach and bowels, whilst at the same time the feet 
and legs are reduced below the proper temperature, the lat- 
ter may be immerced in a tub or bucket of warm water, 
and cloths wet with cold water or vinegar may be applied 
to the region of the stomach and bowels; this is a practice 
from which I have sometimes experienced the greatest 
benefit. Such is the sympathy which exists between the 
different parts of the body and the stomach, that, on many 
occasions, cold applications to the region of this organ 
alone, are found to possess a wonderful efficacy in subdu- 
ing fever, and reducing the general temperature. Con- 
siderable relief may also be derived from bathing the feet, 
and hands in cold water or vinegar, when the heat of these 
parts is much og unequally increased above the natural 
temperature. ? $ 

I have in some cases of prostration to which I have been? 
called upon emergency, found the pulse frequent, small, and 
scarcely perceptible, whilst at the same time there was ar 
caustic burning heat of the forehead and in the region of 
the stomach and bowels, with a preternatural coldness o$ 

lation; whence ensue the various dangerous and fatal phenomena. It is 
well known that the body is more vigorous aud active in the morning^ 
and the circulation stronger than towards evening, more espesially if the 
person has undergone severe exercise. Hence cold bathing is benefit! 
cial in the morning, bul sometimes dangerous at night: Hence also AleX* 
ander nearly lost his life from bathing in the cold waters of the Cidnus a$ 
ter a hard day's march: whereas had he bathed in the morning, while the 
body was free from fatigue and the circulation vigorous, no ill effec? 
would have ensued. In simple excitement, unaccompanied by exhausi 
tion there is no danger from exposure to cold. Hence, as Dr. Currie qb^ 
serves, « 'after the heat of the body-is increased two or three degrees in th^ 
hot bath, it is not only safe, but refreshing', to plunge into the cold bath, 
as I have repeatedly experienced. A practice of this kind prevails, its 
is well known, in Russia. We may therefore safely infer, that in making 
these singular transitions, the heat of the Russian is in the first instances 
increased beyond the natural standard; and it is to this increase that the 
safety as well as the agreeableness of the practice, is to be attributcrf; 
and from all these facts we may conclude, that, when the actual heaiui 
considerably increased and the body is not weakened by fatigue, even 
the presence of profuse perspiration will not render exposure, to a c^- 
Uin degree of cold dangerous."— Qurrie on Water, p, ll'l, .^ 



332 'Cure of Fever. 

the extremities, and a wandering and derangement of mind; 
yet even from such an unpromising condition I have seen 
the patient recover. My plan is to diminish the morbid 
heat of the head and of the central parts of the body by ap- 
plying to the forehead and to the region of the stomach and 
bowels linen cloths wet with cold water, and to restore 
the warmth of the extremities by immersing them in a ves- 
sel of hot water, and by the subsequent application of warm 
bricks should it be necessary, and at the same time raising 
the sinking powers of the system, by the frequent exhibi- 
tion of warm brandy toddy, or wine and water, in the quan- 
tity of two or three table spoonfuls at a time every few min- 
utes till the pulse in some degree revives. 

When the patient is of a delicate constitution, where the 
fever is not very acute, and where there is a disposition to 
prostration and typhus, the affusion of tiped water may be 
substituted for the cold; its power though considerable in 
subduing the excitement, is not equal to that of the cold af- 
fusion, and as it gives a slighter shock to the system it is 
better suited to debilitated^cases that are not able to en- 
dure the cold bath. 

When the heat of the body is not sufficiently increased 
to require the cold affusion, I have founc? Considerable ben- 
efit from sponging it with a mixture of vinegar and water, 
with sometimes the addition of nitre to increase its virtues. 
For the same purpose any of the vegitable or mineral acid 
may be employed ; frictions v,ith lime juice or dilute mu- 
riatic acid are especially useful and refreshing. In a com- 
munication from James M'Gregor, superintendant sur- 
geon of the British army in India, he says that " in the 
pest houses of the Indian army we were ,at first very un- 
successful, and a trial was given to a variety of modes of 
practice. I find on examination of the report, that bath- 
ing with a solution of nitric acid, and sponging the sur- 
face with vinegar and water, and lime juice and water, were 
attended with the best effects." Notice is taken of a new 
method of cure pursued by the physicians of St. Domingo, 
extracted from the first number of the Journal des ofjiciers 
de Sante de Saint Domingue; which consists in rubbing the 
body all over with fresh lime juice or lemon juice. Dr. 
Victor Bally relates a case of its successful employment in 
the most aggravated form of the disease.* Dr. Brandreth 
of Liverpool, giving an account of the benefit of washing 
the body with cold water and vinegar, in typhus fever, ob- 

* Ffirths' Dessertation on the contag, of the Malig. Fever. Phil.jtfed. 
Mus, vol. 1, p. 115. 



Cure of Fever. -333 

serves, " I generally order it to be done night and morn- 
ing, with a large sponge. They usually express great plea- 
sure from its effects, and a sense of great refreshment. It 
immediately lessens not only the heat, but in a singular 
manner the hardness of the skin. It diminishes the fre- 
quency of the pulse, and often lessens, nay, sometimes re- 
moves for a time the delirium. I have known patients who 
refused not only medicine, but every kind of food, readily 
prevailed on, after washing, to take whatever their friends 
offered."! Dr. Moises gives a flattering account of the 
advantages derived from ablutions with vinegar both in 
typhus and synochus ;| and remarks that he has employed 
it both in military and private practice with the most mar- 
ked advantage, " the happy result," says he, " not only 
confirms the beneficial influences of this acid, beyond any 
other medicine with which I am acquainted, but has led me 
to consider it as deserving the serious attention of the pro- 
fession, not only in those diseases, but in all others which 
by their analogy may afford the same obvious indications 
of cure. In two desperate cases attended with vibices a 
cure was thus effected. The acetous ablution was repeat- 
ed every 3d hour, so as to consume from four to six pints 
of vinegar in the course of the day and night. That its 
powers are anti-sceptic and astringent there can scarcely 
be a shadow of doubt ; and that it may form a tertium quid, 
destructive of contagion, I am led to infer from repeatedly, 
I might say uniformly^ observing, that, ceteris paribus, when 
it had been liberally used, the influence of contagion has 
appeared very limited, or altogether destroyed." 

Vinegar was used as an external remedy in fever by 
Galen, who applied it till inflammation of the skin was pro- 
duced. 

Cold drinks are proper with the same view and under 
the same circumstances which authorize the . employment 
of the cold bath ; that is, during the hot stage of fever, 
or whilst the temperature of the body is above the natural 
standard. In the cold stage of fever the drink should be 
warm, and in the sweating stage the temperature is not 
material, provided it is not too cold, which is seldom the 
case in hot climates ; and whilst the fever is at its height, 
the patient may drink freely of cold water acidulated with 
cream of tartar or lime juice, it cools the body generally, 
and favors and promotes the flow of perspiration. 

fMed. Comment, vol. 14, p. 382. 

* Med. & Phys. Jour. vol. 7, p. 337 & sc*. 



334 Cure of Fever. 

The circumstances of the patient, rendering warm bath- 
ing necessary or proper, are different from those which au- 
thorise and require the use of the cold bath. Where warm 
water is applied by affusion it has an effect in reducing the 
temperature of the body; but being less permanent and pow- 
erful in its effects, it can never properly supercede or supply 
the place of the cold bath, except in slight cases, and un- 
der circumstances of delicacy of constitution and debility 
which would forbid the application of cold water. 

The effect of warm water, however, when applied to the 
body by immersion, so as to surround and envelope it, is 
different from that of aspersion or affusion ; and it is only 
under circumstances of debility, exhaustion and reduced 
temperature of the body, where the skin is dry, cool and in- 
sensible, or cold and damp, and the circulation languid, 
that the warm bath, (by which is understood immersion of 
the body in warm water,) is admis sable. The warm bath 
soothes and allays the irritation of the nervous system, 
softens the skin, opens the pores, promotes perspiration, 
increases the activity of the circulation in the smaller ves- 
sels, overcomes their torpor, and restores, in some degree, 
their lost energy and tone, and thereby raises the temper- 
ature of the surface to the proper height. Dr. Brandis, in 
his treatise on the use of the luke-warm bath in fevers in 
general, and particularly in those called slow nervous fevers 
observes that "the principle effect of the warm bath in fevers 
is good in general, since it takes off the spasm of the skin, 
and those parts sympathising with it, increases the excretion 
of the skin, promotes the flow of blood through the vessels, 
and moderates the action of the nervous system, but with- 
out in any way diminishing the \ ital power or irritability. 
Such is the opinion of Cullen, Salle, and of Marcard him- 
self, where he proves that the warm bath does not debili- 
tate." From the circumstance of its having been observed 
that the pulse of a person in a warm bath sometimes falls 
sixteen or twenty beats in a minute, it is inferred byDr. Mar- 
card, and others have entertained the same opinion, that 
the warm bath sometimes causes a diminution of the vital 
principle. Dr. Brandis, however explains this phenome- 
non in a different manner. "A free circulation in the small- 
er vessels of the surface," says he, "must diminish the flow 
of the blood to the heart ; now the stimilus which excites 
the heart to action being less, its contractions become less 
frequent, though without the smallest diminution of the vi- 
tal principle."* There can be but little doubt that could 

* Duncan's An. cf Med. vol. 1, p. 72 t 



Cure of Fevtf. £35 

the warm bath be employed in cases of debility, exhaustion, 
prostration, and torpor, which frequently take place in fever, 
without fatigue and exertion to the patient, so as not to 
cause a still greater exhaustion, this remedy would on ma- 
ny occasions prove highly beneficial. But it unfortunately 
happens, that the fatigue of shifting the patient's linen and 
his movement to and from the warm bath, often overbal- 
ance the benefit derived from the immersion. In deter- 
mining upon this remedy, therefore, in cases apparently 
desperate, these circumstances are to be taken into consid- 
eration. One great reason of the failure of the warm bath, 
in so many instances, is the circumstance of its being put 
off till the last extremity, and then resorted to as a doubt- 
ful remedy, the straw of a drawing man. In cases of sud- 
den and great prostration and sinking of the vital powers I 
have seldom had recourse to it ; and for two strong reasons, 
1st, In most cases it is not convenient to procure an apper- 
atus or trough suitable for the purpose ; 2d, The fatigue 
and exertion to the patient in administering the remedy 
rendering its utility doubtful, or rather affording an argu- 
ment against it. But against the immersion of the extrem- 
ities in warm water there can be no objection, for the rem- 
edy can be applied with little or no exertion to the patient. 
For this purpose the body may be moved a little towards 
the foot of the bed, so as to admit of the feet hanging out 
and being immersed in a bucket of warm water, or the ves- 
sel may be placed in the bed, by bending the legs to a suf- 
ficient angle with the body. 

In slow, lingering and protracted cases, attended with 
debility, torpor and obstructed perspiration, the warm bath 
is a useful remedy. Tepid, or luke-warm water should be 
used, as it softens and relaxes the skin more than hot wa- 
ter, and does not exhaust by over stimulation. 

Considerable difference of opinion has existed with res- 
pect to the nature both of the cold and the warm baths ; 
and by a strange perversion the former has been called a 
stimulant and the latter a sedative. Agreeble to every 
known property of a stimulus, heat possesses this power in 
an eminent degree. If heat, therefore, is a stimulus, which 
it is presumed none will deny, and cold is a diminution of 
heat, it necessarily and logically follows that cold is a sed- 
ative, or an abstraction of stimulus in proportion to the di- 
minution of heat or caloric. This is not a mere matter of 
idle speculation, destitute of practical utility, it is the es- 
tablishment of a rational and scientific principle in medicine. 
If cold is a stimilus why is it found beneficial in the hot 



336 Cure of Fever. 

stage of fever, where our object is to abstract all unnecessary 
stimuli, and where we ha' e recourse to means the most di- 
rectly sedati v e of any within the routine of the healing art, 
viz. blood-letting ? If cold is a stimulus.-, and so useful in 
the hot stage of fe* er, we should, by the soundest principles 
of analogy, be authorized in the exhibition of other stimuli 
with the same view ; the argument would appear conclusive 
and unanswerable : and the inference necessarily follows 
that cold and ardent spirits, are highly beneficial and re- 
quisite in the hot stage of fever. It is true there are 
stimuli of different degrees of power and activity, and it 
might be contended that cold is a moderate stimulus. But 
as we judge of the nature of agents by their effects upon the 
body, we usually call those stimuli which increase the ex- 
citement and rouse the energy and mobility of the muscu- 
lar and nervous systems. Now we know that this is not 
the case with cold ; as is strikingly exemplified in the appli- 
cation of the cold bath, which reduces the febrile excitement, 
subdues the heat, and diminishes the strength and frequen- 
cy of the pulse, in the same manner as blood-letting, but 
more suddenly. And from what we are capable of observ- 
ing we can have no hesitation in believing, that the expos- 
ure of the body to a medium of absolute frigidity would 
instantly extinguish every vestage of vitality. But the ac- 
tion of cold, it is said, strengthens the body, therefore, it 
must be a stimulus. And how stands the reverse of this 
proposition ? The operation of heat weakens the body r 
therefore, heat must be a sedative. We must be aware, 
however, that it is a well known property of all stimuli that 
their excessive operation on the body exhausts the power 
both of the muscular and nervous systems, and produces 
debility and attomy . And on the contrary the abstraction of 
stimuli increases the excitability of the sensible and mov- 
ing fibre. 

During the intervals of the operation of cathartics the 
patient may take with advantage a febrifuge powder men- 
tioned under the head of mercury, every three hours. 

To assist in promoting perspiration I at the same time 
direct a tea-spoonful of the spirits of nitre and cream of tar- 
tar every two hours, alternately, so that oue of them may be 
taken every hour. Cream of tartar and water, tamarind 
water, diluted lime juice, molasses and water, vinegar and 
water, may all be used as common drinks. 

An excellent febrifuge will be found in the use of the 
alkalies and lime juice given in a state of effervescence. Of 
the alkalies the most agreeable is the carbonate or super- 



Bure ofBev&. Q37 

carbonate of soda ; fifteen grains of this may be dissolved 
in a tumbler, in about a table spoonful of water, and when 
the patient is ready to take it, about two table spoonfuls of 
lime juice may be poured from another tumbler into the 
one containing the soda, and the patient is directed to take 
the mixture immediately, whilst it is in the act of efferves- 
cence. There should always be rather more acid than is 
necessary to saturate the alkali. The cabonate of potash 
(salts of tartar) may be substituted for the soda, where the 
other cannot be obtained. In order to increase the appi- 
rientand febrifuge qualities of the effervescing mixture I 
frequently add cream of tartar, mixing a tea spoonful in 
the tumbler containing the lime juice. This mixture may 
be taken every hour, or every two hours, according to the 
degree of fever. The spirits of nitre is also a useful fe- 
brifuge and diaphoretic ; the virtues of which may be in- 
creased by adding about fifty drops of antimonial wine to 
an ounce of the spirits of nitre ; giving of the mixture a 
tea spoonful every hour, during the continuance of the fe- 
ver. Where the stomach is irritable and disposed to reject 
the substances received, we may sometimes add a little 
paregoric, or a few drops of laudanum to the effervescing 
draught, which will at the same time increase its sudorific 
powers. As answering the purpose of the carbonate of so- 
da, salts of tartar and lime juice, theSeitlitz or soda pow- 
ders; as they come prepared, may be employed with advan- 
tage ; dividing the papers into two or three portions, so as 
not to oppress and overload the stomach. To render them 
the more agreeable a little loaf sugar or syrup may be ad- 
ded to each dose. 

My reason for employing this variety of sodorific rem- 
edies is that they mutually assist the operation of each other; 
no sudorific alone will be found so effectual as in combi- 
nation with others, which, though possessing in them- 
selves, inferior efficacy, increase the virtues of the more 
powerful. 

To promote perspiration, is a leading indication in the 
treatment of fever ; and to effect which, all the remedies 
that have been mentioned have a strong and natural tend- 
ency. There is a due medium in the temperature of the 
surface, as well as vigor in the exhalents, necessary to salu- 
tary perspiration : where the former is too high or too low ? 
or the latter too weak, this evacuation is either suppressed^ 
or if it flows from relaxed and debilitated vessels, cannot 
fail to prove prejudicial. Where the suspension of the per- 
spiration proceeds from excessive excitement we hare re» 
s2 



338 {sure of Fever. 

course to bleeding, vomiting, purging, the cold bath, and 
other febrifuge remedies : where profuse and morbid from 
relaxation and debility, we endeavor to restore it to a heal- 
thy state by moderate covering, bark, wine and the mineral 
acids. 

A warm and natural perspiration, though free and copi- 
ous, is safe and salutary, and should be encouraged, and 
supported : profuse, cold, slippery and morbid sweats, at- 
tended with weakness and prostration of the system, should 
be checked and subdued. 

It is proper to remark that there is a very material differ- 
ence between salutary and morbid perspiration. Perspir- 
ation, to be servicable, requires a due degree of tone and 
vigor in the exhalents, whereby the perspirable matter a- 
lone may be discharged, but when the cutaneous vessels 
are debilitated and relaxed the serosity of the blood exudes 
from their orifices, and the perspiration, instead of proving 
servicable, drains off the natural juices of the body, wastes 
the solids and exhausts the patient.^ 



* Even the sweating sickness of England was cured by promoting- per- 
spiration. In illustration I will here subjoin a short account of this dis- 
ease in relation to this subject, as described by Hollinshead. "The 
sweating sickness of England appeared there at different times from 
1483 tili 1554. The discription given of it by Caius is terrible, like the 
plague at Athens. It was cured by sweating the patient twenty -four 
hours. In some there was a necessity to repeat the sweating." (See Dr. 
Friend's History of Physic, part 3, p. 333.) At length by diligent ob- 
servation of those thai escaped, a remedy was found for that mortal mal- 
ady, which was this : if a man was taken in the day time with the sweat, 
then should he streight lie down with all his clothes and garments, and 
continue in his sweat four and twentie hours, after so moderate a sorte 
as might be. If in the night he chanced to be taken, then should he not 
rise out of his bed for the space of four and twentie hours, so casting the 
clothes that he might in no wise provoke the sweat ; but lie so temperate 
that the water might distill out softly of the own acord, and to abstaine 
from all meate, if he might so long suffer hunger ; and to take no more 
drinke, neither hot nor cold than would moderately quench and assuage 
his thirsty appetite. Thus in hike warm drinke, temperate heate, and 
measurable clothes, many escaped. Few which used this order after it 
was found out, died of this sweat. More one point diligently above all 
others in this cure is to be observed, that he never did put his hands out 
of bed to refresh or cool himself, which to do is no less jeopardie than 
short and present death." We are further told by the same author that 
this disease, "began about the one and twentieth of September, and 
continued until the latter end of October, being so sharp and deadlie, 
that the like never was heard of since man's remembrance before that 
time ; for suddenly a dreadful burning sweat so assailed their bodies and 
distempered their blood with a most ardent heat, that scarce one among 
a hundred did escape with life ; for all in a manner as soon as the sweat 
took them, or within a short tins aftsr, yiej^e^ &$ ghost "—Holler!*' 
head, p. 763, 



Ckire of Ftver. 339 

In the progress of the fever cream of tartar, in the quan- 
tity of two or three tea spoonfuls at a time will be found a 
useful laxative to open the bowels, and an excellent febri- 
fuge, acting as an apperient, diuretic and diaphoretic. 
Sometimes it will be rendered more agreeable by the ad- 
dition of a little sugar and lime juice, and to render its ap- 
perient powers more active senna and manna may be some- 
times added with advantage. 

The state of the stomach is much influenced by the con- 
dition of the surface of the body : where this is moist, with 
a warm and fluid sweat, the stomach is generally compos- 
ed ; at least, the continuance of the perspiration has a ten- 
dency to relieve the irritability and sickness of the stom- 
ach. And the practitioner has, probably often remarked 
that the patient is stronger during the continuance of the 
perspiration than he was before. Perspiration is one of 
the most important functions of the body, which can never 
be suppressed, even for a few hours, without producing 
disorder in the system. The retention of the perspirable 
matter soon throws the body into an ardent fever, and de- 
ranges every part of the animal economy. If such is its 
importance to the healthy condition of the body, how great 
must be its influence and benefit in those diseases which 
owe their existence to a vitiated condition of the animal 
fluids? Even the venerial, the most loathsome and horri- 
ble of all diseases, is often cured by the use of such reme- 
dies alone as promote perspiration. A very favorite re- 
medy for the plague in Syria is frictions with warm oil 
c>ver a kettle of coals in a close room, which soon brings on 
a copious perspiration, and cures the disease.^ 

* Sydenham found when a sweat was kept up for twenty -four hours, it 
was the best cure for the plague and pestilential fever. He says that the 
patient is always stronger when the sweat flows ; that several, by his ad- 
vice, who were keprin a sweat for twenty -four hours, so far from com- 
plaining of greater weakness in consequence, that they declared that in 
the same proportion as the superfluous humors were earned off, they 
perceived their strength increase. That while the sweat continues, the 
patient judges himself in a fair way of recovery, and, in the opinion of 
the attendants, seems in no further danger ; but as soon as the sweat 
ceases, and the body begins to dry, he grows worse, and a kind of relapse 
is occasioned. He directed the sweat to be kept up for twenty-four 
hours, by draughts of sage posset drink, taken now and then, strictly 
cautioning against wiping off" the sweat, and not allowing the patients 
linen to be changed, however moist or foul it was, until twenty -four hours 
after the sweat was gone off; during" which time he was advised to be 
careful not to get cold, but to let his linen dry on his body, to take all 
his liquids warm, and continue the sage posset drink. The next morn- 
ing a purge was given. He says he did not loose a single patient after 
^le began this process. 

p^ius, after mucji unsuccessful experience, found ty&t tkc cure of ev$ts 



•340 -&ure of Few-, 

^Blistering is often serviceable in the endemic fever3 of 
the southern states, as well as in those of sickly and tropi- 
cal climates, more particularly where the patient is affected 
with local pains or distress, either in the head or stomach. 
The application of a moderately large plaster to the region 
of the stomach, will often be found of essential service in 
relieving the sickness, vomiting, and burning sensation of 
that organ. Nor when the symptoms are violent and se- 
vere, should we wait until these distressing affections have 
come on, before we have recourse to this remedy : the pre- 
ceding steps which have been taken, such as bleeding, vo- 
miting, purging, and the cold bath, will, in all probability, 
have reduced the excitement sufficiently to remove all ap- 
prehension of its being aggravated by the application of 
the blistering plasters. Besides, even in cases of high fe- 
brile action, this apprehension is more imaginary than real; 
in all pleuritic cases, I have uniformly had recourse to 
blistering after blood-letting, whether the latter operation 
had or had not subdued the excitement, and with the best 
effect ; the disease yielding upon the drawing of the blister. 
In fever, this remedy, to be of service, should be employed 
at a pretty early period of the disease. Many physicians 
are in the habit of only having recourse to blistering when 
the symtoms of approaching dissolution have come on ; — 
when the pulse has sunk, the body become cold or reduc- 
ed in temperature, and alienation of mind and stupor have 
seized upon the patient. Although their application under 
these circumstances may do no harm, we can scarcely flat- 
ter ourselves that they can be of any material service. But 
at the same time, that there can be no objection to their 
employment, there is still a prejudice in their favor, and 
whether this is well or ill founded, no injury can result in 
complying with it. I have, moreover thought, that the 
pain and excitement produced, and the quantity of water 
discharged by extensive blistering, has often been instru- 
mental in bringing about a salutury change in cases appa- 
rently desperate. If blistering is a serviceable remedy, of 
which I have no doubt, it is manifest that it will be most 



the sweating sickness, consisted in keeping the patient in bed, and pro-, 
moting a continued and protracted sweat for twenty-four hours. — De 
Uphem. JBritan. p. 110. And Helmont asserts that all fevers maybe 
cured by sweating. For this purpose he employed the diaphoretic pre-' 
eipiiate of Paracelsus, a single dose of which, he affirms, was sufficient 
for the cure of any case of fever. "Id remedium esisudori/icum. Etiam 
istud remedium est Prsecipitatus Diaphoreticus Paracelsij qui Ojtnna** 
sajiat febiim nwiga potion?.— Befehribus, gap, XI Y, 



Cure ofFtv&. >341 

beneficial when employed before symptoms of prostration 
and collapse have come on. Under these latter circum- 
stances, blisters are frequently resorted to at too late a stage 
to be of any service ; whereas, had they been employed at 
an earlier period, the alarming and fatal symptoms might 
have been prevented. When blisters are resorted to in 
cases of prostration and collapse, other stimulating means 
should at the same time be resorted to, as wine sangre or 
brandy toddy, immersing the feet and hands in hot water, 
bathing the extremeties with warm spirits of turpentine, the 
application of sinapisms to the palms of the hands and soles 
of the feet, &c. 

In affections of the head, as pain, delirium, or stupor, 
the application of blisters to the temples, forehead, or back 
of the neck frequently affords signal relief. 

Blistering is also of service in bringing fever to a crisis 
after other remedies have failed. Sometimes, notwith- 
standing, the use of blood-letting, emetics, purgatives, the 
cold bath, &c. the fever will still continue, seizing upon 
the brain, producing derangement, coma, and alienation of 
mind ; under these circumstances, the drawing of a few 
blisters on the back of the neck, extremities, and region of 
the stomach sometimes operates like a charm in removing 
the unfa^ orable symptoms, subduing the fever, restoring 
the intellect, and removing the anxiety and restlessness of 
the patient. 

This remedy is likewise useful in preventing a return of 
the paroxysm after a remission. When, from previous 
alarming symptoms, I have had reason to apprehend the 
serious consequences of another exacerbation, I have some- 
times succeeded in preventing the return of the fever by 
the application of half a dozen blister plasters to different 
parts of the body. The places to which I generally apply 
them, are the inner side of the wrists and ankles, the pit of 
the stomach, and the back of the neck : calculating the 
time of the succeeding paroxysm, the blisters should be 
applied so as to exert the full force of their operation just 
before the period of the expected chill. 

The association which exists between the nervous and 
vascular systems will probably afford an explanation of the 
operation of blisters in preventing the return of paroxysms 
of remitting fevers, in the same way that other stimuli ac- 
complish the same object. The suspension of the opera- 
tion of the morbid cause occasioned by blisters, though 
not permanent, affords an opportunity for the more effectual 
application of other remedies 



342 Cure of Fever. 

Dissections show that the stomach is generally more or 
less affected in bilious fevers. In every case which has 
come under my observation, when the body has been open- 
ed, traces were observed of considerable preceding inflam- 
mation ; the veins have appeared distended with dark gru- 
mous blood, and the villous lining of a deep red, as if from 
successful injection. The known efficacy which blisters 
possess in relieving local inflammations, points them out 
as valuable remedies in all cases of bilious remitting fever, 
in which an inflammation of the stomach, as marked by 
nausea, vomiting, tension, soreness, tenderness, and a burn- 
ing sensation in this organ, is one of the most troublesome 
and distressing attendants of this disease. And though the 
probability is, that in many cases these traces of apparent 
inflammation proceed from a relaxation of the vessels and 
a dissolved state of the crasis of the blood, yet we have 
reason to conclude that on some occasions this organ, as 
well as others, is affected with actual inflammation in idio- 
pathic fever. There can be as little doubt, that in many 
cases the brain, cerebellum, and spinal marrow, are also the 
seat of inflammation in fever. These affections are indi- 
cated by the various symptoms which have been previous- 
ly noticed. And the decided benefit, which on many oc- 
casions I have experienced by blistering the back of the 
head and neck, I am disposed to attribute to the abstrac- 
tion or removal of inflammation thereby occasioned, from 
the cerebellum and the cervical portion of the spinal marrow. 
When the fever assumes the remitting type, as it gener- 
ally does, at least during some part of its progress, the Pe- 
ruvian bark will be found of essential service in cutting 
short the disease, and preventing the return of the parox- 
ysms, provided the remissions are sufficiently distinct to 
admit of its exhibition. But little benefit, however, can 
be expected from the use of this remedy, unless the stom- 
ach and bowels have been cleansed by the previous opera- 
tion of an emetic and cathartic ; for when there is an ac- 
cumulation of morbid bile in the prims vise, the exhibition 
of bark, instead of proving beneficial, will serve only to op- 
press and sicken the stomach, to render the patient restless 
and uncomfortable, and to increase and aggravate the fe- 
ver. There are besides some constitutions with which the 
bark will not agree in any form ; although the person at 
the time of taking it may have been entirely clear of fever, 
one or two doses are sufficient to oppress and overload the 
stomach, to accelerate the pulse, occasion a flushing of the 
face, and a burning sensation at the epigastrium, Others 



Cure of Fever. 343 

again, can take an ounce at a single dose, without expe- 
riencing any inconvenience or uneasiness, and with the 
best effect. 

When the remissions are short, the bark should be ta- 
ken often and in considerable doses. From one to two 
tea-spoonfuls may be taken every hour or two, or in such 
quantity as the stomach can bear. 

When the bark cannot be taken in substance, it may be 
given in the form of infusion, and to enable it to sit easier 
on the stomach, aromatics, as cinnamon, cloves, &c. may 
be added to it. When it is desirable to keep up the per- 
spiration, as it frequently is, with the view of preventing 
the return of the fe^er or chill, snake root (Serp. Virg.) 
may be usefully added to the infusion of bark. The snake 
root, moreover, possesses the advantage of covering the 
disagreeable taste and preventing the nauseating effects of 
the bark. Should the patient be entirely free from fever, 
wine may be used with the bark ; but otherwise it will be 
safer and more serviceable to give the cincona without this 
addition, until a complete solution of the fever is effected : 
wine and bark will then form a valuable restorative and 
tonic. 

Bark is also serviceable in checking the profuse cold and 
clammy sweats which sometimes take place in the progress 
of the fever: and in such cases, the elixir of vitriol may 
be added with advantage ; the latter remedy, indeed, under 
all circumstances may be usefully given in combination 
with the bark, as it causes the latter to sit easier on the 
stomach, and resists what was formerly called the septic 
or putrid tendency of the disease, but which I have previ- 
ously taken the liberty to call the alkalescent tendency, or 
disposition of the fluids. 

The circumstances which render the exhibition of the 
bark proper and necessary are, the declining strength of 
the patient, the sinking of the pulse, the cold and clammy 
state of the surface of the body, and the subsidence or evi- 
dent remission of the fever. To exhibit it under any other 
condition of the system, it cannot fail to prove injurious ; 
by constricting the surface, shutting up the excretions, in- 
creasing the heat and anxiety of the body, and giving rise 
to congestions of blood in the internal viscera. 

Bark is not always, nor perhaps in a majority of cases, 
admissible in the typhous, or asthenic state of fever. In 
this state there is not unfrequently a fulness of the pulse 
and a heat of the skin altogether incompatible with the 
employment of bark j but when the circulation is languid. 



34-4 Cure of Fev&'. 

the skin cool, and the patient much debilitated, bark and 
wine may be given with advantage. 

Where the disease, however, has been properly treated, 
bark and wine, as stimulants, will seldom be required, un- 
til a complete remission has been established, unless the 
fever is of a very malignant character, where typhoid symp- 
toms, accompanied with prostration, are apt to supervene 
at an earlier or later period of the disease : in such cases 
bark and wine become necessary. In their employment 
we should be regulated as to the quantity required by their 
effects upon the constitution ; our object is to keep up a 
moderate action till the system recovers, in some degree, 
the proper exercise of its various functions. As life in 
such cases hangs suspended by a feeble thread we must be 
cautious in its management ; by stimulating too highly we 
exhaust prematurely the poor remains of vitality, and split 
upon the fatal rock which we have been endeavoring to a- 
void. 

There are, probably, but few instances in which more 
than a pint or a bottle of wine will be necessary in the 
twenty-four hours. In a very few cases I have found it 
necessary to give, in the course of the day and night a 
quart, or rather more of Madeira, diminishing the quanti- 
ty by degrees as the system resumes the exercise of its 
para'Iized and suspended functions. Upon this subject no 
certain rules can be prescribed, as much will depend upon 
the strength and quality of the wine ; the age, sex and con- 
stitution of the patient ; his former habits with respect to 
temperance both in eating and drinking ; the stage of dis- 
ease ; the degree of torpor and debility ; the nature of the 
epidemic, as being more or less malignant ; and the effects 
of the wine upon the patient. 

When the debility and prostration have come on sud- 
denly, wine should be given with more freedom and in 
greater quantity than when the debility has been gradual 
in its approach ; and it is only in such cases that large 
quantities of wine are admissible. If the effects of this 
stimulus are transient, if the pulse is easily and suddenly 
excited by it, and as suddenly falls again to its former 
weakness, but little benefit can be expected from it, and by 
pushing it too far, under such circumstances, we exhaust 
the vital principle and hasten the death of the patient. If, 
on the contrary, the immediate excitement is less consid- 
erable, but more moderate and permanent, giving tone and 
stability to the pulse, and imparting strength to the sys- 
tem, we are authorizetl to continue ijis employment of the 



Cure of Fever* 345 

remedy with the reasonable prospect of advantage. Though 
ev*en in cases where bark and wine are beneficial we should 
be cautious in pushing the stimulus too far,, otherwise we 
shall injure rather than benefit the patient. 

Though bark and wine are often given together, the cir- 
cumstances which require their use are not in every in- 
stance precisely the same. In all cases of sudden prostra- 
tion, and in the asthenic stage of the disease, when the 
pulse is permanently weak, bark and wine may both be us- 
ed with advantage, provided the stomach is able to retain 
them, otherwise the wine should be given without the bark. 
But it often happens in bilious fevers that the remissions, 
though, as the term implies, not amounting to a complete 
apyrexia, are yet sufficient to admit of the exhibition of 
bark alone, or, what in many cases is still better, in com- 
bination with snake root, so as to promote perspiration ; 
and which instead of increasing the fever, when the ex- 
citement is slight is often found to moderate and subdue 
it : in such cases wine is inadmissible, and would be found 
to aggravate the fever.* 

Some physicians, and of this number are Mr. Cleghorn 
and Dr. Jackson, are of opinion that the bark should be 
given without waiting for the operation of cleansing the 
first passages; observing that this colluvies of the stomach 
and bowels is owing to that condition of the system which 
supports the fever, and that by putting a stop to the latter 
the morbid condition of the primal vise is corrected, and 
the cause of these impurities removed. This change, says 
Mr. Cleghorn, is affected by the bark, which by corrobora- 
ting the solids, enables them to throw off the excrementi- 
tious nuids by the proper emunctories.f Mr. Cleghorn thinks 
moreover, that it may be laid down as a general rule in all 
cases of fever, to give the bark liberally and without hesi- 
tation about the third or fourth period of the disease, wheth- 
er evacuations have been previously used or not. A sim- 
ilar practice was pursued by Dr. Jackson in the fevers 
of America : and he informs us that if in the autumnal 
months symptoms of malignity appeared, he generally seiz- 
ed the first intermission for exhibiting the bark, without 
the previous exhibition of either an emetic or cathartic, 

* The great advantage of wines in fever over spiritous liquors is owing" 
to the circumstance of their containing more or less of an acid and a sac- 
charine matter. All wines give a red colour to paper stained with turn- 
sole. Chaptal has ascertained that the acid found in greatest abundance 
m wine is the malic, but he found traces also of citric acid, and it is pro- 
"Mc that wine is never destitute of tartar. See Thompson's Gkeiftistry, 
■y Diseases of Minorca, p. 130, 

T 2 



346 due cj Fever. 

though the bowels should be oppressed with coiiu vies, 
fie gave two drams every two hours, during the absence 
of the fever. Two ounces, he observes, taken in the course 
of eight or ten hours, were more effectual than double the 
quantity in small doses at distant intervals. 
. This practice may be very well suited to some cases, as 
I have myself experienced : this, however, can only be as- 
certained from trial, and 'where there is no immediate dan* 
ger to be apprehended, I always premise the use of an e- 
rnetic or cathartic before giving the bark. Where this 
practice is omitted, I have rejnarked that this medicine is 
apt to sicken and oppress the stomach, and to produce a 
febrile commotion in the system, which it is sometimes 
difficult to subdue. Besides, bark sometimes constipates 
the bowels, and the interposition of purgatives are then in- 
dispensably necessary. It may be laid down as a general 
rule that where the pulse is tense, the bark is inadmissible, 
more particularly in the early stage of fever. It is true 
that, on some occasions, where I have been certain that 
the stomach and bowels have been well cleansed, I have 
known the pulse, from being somewhat tense and hard, be- 
come softer from the exhibition of the bark, and the skin, 
which was before dnx become moistened with a general 
perspiration after the first and second dose. But should 
the bark be exhibited under the circumstances of a tense 
pulse, though the skin should be cool and no other symp- 
toms of fever be present, yet if at the same time there 
should exist a foul condition of the stomach and bowels, 
there will be danger of a fatal congestion, inflammation or 
gangrene of some of the internal viscera. ■ 

Where the debility is great and the symptoms of the 
previous paroxysm have been alarming, the stomach and 
bowels remaining uncleansed, I have sometimes prescrib- 
ed with the best effect the bark in conjunction with rhu- 
barb ; say five grains of rhubarb to every tea-spoonful of 
bark, repeated as often as the stomach will bear ; the rhu- 
barb to be continued till the bowels have been sufficiently 
cleansed ; and to be checked in its operation should this 
Drove too severe, by the exhibition of thirty or forty drops 
of laudanum. 

From the presence of inflammatory symptoms bark may 
; . i und ious he cominencment or during the ear- 

ly stag* fevei yet be given with advantage at a 

• eriod, after the :r lam y symptoms have 

] subdued by proE . tcuations, ■ the continuance 



Cure of Fever. 347 

When from idiosincracy of constitution the patient fi 
unable to take the bark, when the fever begins to assume 
the tvphoid character, or when the remissions are not suf- 
ficient to authorize the use of the bark, vegetable bitters, 
as quassia, gentian and columbo, with snake root and a 
portion of some aromatic, as canella alba, cinnamon or 
cassia may be usefully substituted. They produce less 
heat and excitement than the bark, and sit more easy en 
the stomach. 

Sometimes, when we are apprehensive of increasing the 
fever, where this is slight and attended with a dry skin, the 
infusion of snake root alone maybe given with advantage. 

It often happens in the remitting bilious fever, that the 
stomach is too irritable to retain the bark in any form, and 
yet, from the state of the patient, it is of importance that 
it should be exhibited, under such circumstances, and when. 
the remissions are short and the debility great, I direct the 
bark to be given by injection : one or two ounces mixed 
with a small quantity of warm water, with the addition of 
eighty or a hundred drops of laudanum, may be exhibited 
in this way with the greatest advantage : Besides when 
given in this manner, though it acts less powerfully on the 
general system than when received into the stomach, we 
derive this important advantage, that we have it in our 
power immediately to remove it upon the recurrence of 
the exacerbation, should this take place ; whereas, when 
taken by the mouth, by remaining in the stomach and bow- 
els upon the rise of the fever, the symptoms are consider- 
ably aggravated by it. 

The sulphate of quinine, a preparation of bark, has lately 
been introduced into medical practice. One grain is repre- 
sented as equal to one dram of the powdered bark. It is giv- 
en in pill, or suspended in water with a little essence of pep- 
permint or cinnamon. I have never used it sufficiently to 
speak in positive terms of its efficacy ; the extravagant 
price of the article will, moreover, probably exclude it in 
a considerable degree, from extensive and general use. 

As Champaigne wine, cider, perry and porter all contain 
a considerable quantity of carbonic acid, where stimulants 
are indicated they maybe advantageously prescribed. As 
the carbonic acid of these liquors allays the irritability of 
the stomach, they are particularly adapted to those cases 
of weakness and inquietude of this organ resulting' from 
attacks of remitting fever. 

I have said but little concerning the use of distilled spir- 
its in the treatment of this disease, because they are by no 



348 Cure of Fever, 

means equal to fermented liquors, and can seldom be em- 
ployed for the same purpose, except in cases where the lat- 
ter cannot be obtained of a good quality, or where they are 
found to disagree with the stomach. 

In sudden emergencies, where the patient becomes in a 
short time alarmingly prostrated, with sinking of the pulse 
and a coldness of the surface and extremities, as not unfre- 
quently takes place towards the termination of the parox- 
ysm, or from the severe operation of an emetic or cathar- 
tic, where the cause is powerful, the constitution delicate, 
or the reaction weak : under such circumstances we are cal- 
led upon to use every exertion to arouse and restore the 
sinking energies of nature. In this we may sometimes fail, 
more especially in cases which have been of considerable 
continuance, the constitution delicate and weak, and when 
the sinking has come on as the result and progress of the 
fever and not from any sudden evacuation. We should 
never, however, in such cases abandon our patients in des- 
pair ; provided the intellect is clear, the brain free from 
lethargy or coma, there is still considerable hope of a recov- 
ery, more especially if the patient is composed and free 
from anxiety and pain. I have seen and treated patients 
whose extremeties were cold as marble, and in whom no 
pulse was perceptible at the wrist, who gradually emerged 
from this prostration, after remaining in this state of tor- 
por and death-like coldness for five or six hours. In such 
cases stimulants internally and externally should be em- 
ployed ; we should exhibit every few minutes a table spoon- 
ful or two of hot brandy toddy tolerably strong, or wine 
sangre; hot and stimulating applications should be made 
to the extremities, as bathing the arms, feet and legs with 
hot brandy or spirits of turpentine, applying to the inside 
of the arms and legs stimulating cataplasms of canthai ides, 
mustard and spirits of turpentine ; immercing the feet and 
hands in hot water, and subsequently keeping them warm 
with heated bricks or irons, or boiided blocks of wood. 
These means should be persisted in until the natural warmth 
returns and the pulse is restored to some degree of vigor : 
the stimulus should then be gradually diminished and 
withdrawn. 

Both the vegitable and the mineral acids have been em- 
ployed in fever with universal confirmation of their utility. 
The vegitable acids as the juices of limes, lemons and oth- 
er acid fruits, as being more grateful, may be substituted 
for the mineral, and used, probably, with equal advantage. 
The mineraj, as possessing more of £he tonic property, are 



Cure of Fever \ S49 

better suited to the advanced stage of the disorder. They 
are all highly serviceable and refreshing in fevers of a bil- 
ious and malignant character. They correct the morbid 
secretions of the abdominal viscera; and serve to act on the 
materies morbi of the prima? viae, in the same way as the 
fumes of the mineral acids neutralise and destroy infection 
externally, whenever they come in contact with it. 

The laws of contagion, observable in diseases which un- 
equivocally own their subjection, establish the- fact that 
the morbific matter from which they originate, and to 
which they owe their immediate existence, remains un- 
changed in the system, possessing there an assimilating 
power, by which it converts a portion of the fluids to its 
own nature, and which, in its turn, is also capable of pro- 
pogating the same disease. If this be the case in diseases 
of an acknowledged contagious character, as the small- 
pox, lues, &c. are we not authorized to conclude that the 
same thing takes place in all diseases arising from infec- 
tion, whether it is the infection of putrefactive miasms, 
or of the ship, jail, or hospital fever ? We have previous- 
ly noticed the efficacy of acid fumigations in destroying 
the noxious and morbid miasms of infected places ; we 
have also noticed the circumstance of various substances 
being received into the body, and passing through the cir- 
culation unchanged, and again manifesting their peculiar 
properties and odours in the various excretions : from 
which it appears that there are various substances received 
into the body totally unfit for the purposes of nutrition, or 
for supporting the healthy functions of the animal econmy s 
and which are either eliminated unchanged, or, being re- 
tained, become the pabulum and occasion of derangement 
and disease to the general system. From these consider- 
ations we are furnished with a clue to guide us in our re- 
searches into the intimate nature of endemic fevers ; and 
the obvious conclusion that forces itself upon our under- 
standing is, that the essential causes of these diseases are 
received unchanged into the mass of the circulating fluids, 
which, after having become assimilated in a certain degree 
to the peculiar nature of the morbid poison, produce de- 
rangement in the vascular and nervous systems ; and ex- 
citing the heart and arteries to unnatural and morbid ac- 
tion, give rise to the various symptoms and phenomena of 
fever. The practical purposes to which this knowledge 
may be applied is of the first importance in the treatment 
of fever arising from putrefactive and infectious miasms, 
such as the endemics of the southern states, and of all hot 
and tropical climates, 



350 G-ure of Fever. 

It is in this way that we would explain the benefit de- 
rived from the use of acids in the treatment of fever. It 
is upon the same principle that acids and ^cescents prove 
so efficacious in scurvy and scorbutic disorders, between 
which and typhus, under its various malignant aspects and 
denominations, we have already pointed out the analogy 
and relation. The causes of fever are less obvious than 
those of scurvy • the latter disease evidently arises from, 
the excessive or disproportionate and almost exclusive use 
of animal food ; fever of the endemic kind arises from 
volatile and gaseous matters, the result of animal and veg- 
etable decomposition, floating in the asmosphere, and from 
it received into the mass of circulating fluids ; in which 
they produce a contamination similar to that which exists 
in the fluids of scorbutic patients. 

It may be asked, if such is the similarity in the essential 
causes of fever and scurvy, why do we not observe the 
same vascular excitement in the latter as in the farmer 
disease ? To this, I would answer, that the matter of scur- 
vy is probably not so active, poisonous and stimulating as 
that of fever ; though in this, there is some variation, and 
we read in various authors of epidemic scum ies having 
made their appearance in besieged towns, camps and ar- 
mies, which from their malignancy and mortality, have 
been mistaken for the plague itself. In another work,* I 
have given an account of the pestilential scurvy of Terre- 
aux B cuffs, which committed such ravages in the Ameri- 
can army, and Which equalled in fatality, the plague of Eu- 
ropean writers. May not an inferior as well as an exces-, 
sive influence of the same cause operate as a sedative, which 
when in neither extreme acts as a stimulant ? Is not this 
exemplified at the commencement and termination of cases 
of endemic fever ? Languor, lassitude and various signs of 
debility, with a frequent, weak and small pulse, are the 
premonitory symptoms of most fevers, and which frequent- 
ly continue for three or four days before the full marked 
character of fever is completely disclosed. This first stage 
of fever corresponds with the condition of the system- in 
scurvy, in which a slow poison, operating on the heart and 
blood-vessels, weakens their energy of action, and relaxes 
the substance and impairs the strength of the muscular 
iibre. 

Could acids, taken internally in fever, come immediate* 
Iv in contact with the morbific" matter, we have reason to 

* Topography and Diseases of Louisiana. 



Cure of Fever. 351 

conclude that they would instantly destroy it, and cure the 
disease by neutralising the virus. But it is well known that 
the stomach has considerable power in changing the sub- 
stances taken into it, so that it is only when the system be- 
comes over charged with particular substances, that they 
manifest and exert their influence upon the general habit ; 
and as the matter of fever is diffused and intimately blend- 
ed, with every portion of the animal body, its antidote must 
be co-extensive in diffusion, in order to neutralise and de- 
stroy its morbific property. But as fe\ er is frequently a* 
disease of such rapid progress and speedy termination as 
to produce an irreparable lesion of the constition before 
the system can be sufficiently impregnated with the anti- 
dote to bring about a solution of the disorder, a leading 
object and indication in its treatment will be to palliate the 
most urgent symptoms, by the use of the remedies before 
pointed out, until the expulsion and correction of the mor- 
bific matter shall be effected by nature and art. 

Were fever a disease equally slow and lingering in its 
progress as scurvy, we have reason to think that acids and 
acescents would be found equally effectual in its cure.— 
Health is not immediately restored to scorbutic patients 
by a change of diet and vegetable acids ; to renew and re- 
store the healthy condition of the animal fluids is the work 
of time, proportionate in its duration to the inveteracy or 
mildness of the disorder, and to the quantity and regulari- 
ty in which the specific correctors of the scorbutic condi- 
tion of the fluids are taken. 

Yet, notwithstanding, the various difficulties that oppose 
themse'ves in the treatment of fever, in every point of view 
acids will still be found extremely beneficial. They mod- 
erate the excitement, promote the secretions of perspira- 
tion and urine, and operate as laxatives upon the bowels. 
The ancient physicians are extravagant in their praise of 
these remedies ; to which they Considered them entitled 
as well from theory as experience of their benefit. Their 
doctrine in malignant fever was, that of putridity, and of 
course, the obvious indication was the exhibition of anti- 
dotes to this, putridity. These remedies they called anti- 
septics, and exhibited them with a liberality proportionate 
to the septic or putrefactive tendency which they believed 
to exist. Such, however, was the imperfection end ob.. 
rity of medical science, that the p: a< tiee was founded on 
no fixed or rational principles, and aldiovgh genera 
rience might establish the utility of certain articles ; y 
on various occasions we find them i#cl.ujging in a vd 



35& -Gur-e of Fever. 

absurd speculation, and giving advice about the acids and 
alkalis, salts, slime, acrimonious, &c. as indespensibly ne- 
cessary to be discriminated in the treatment of fevers; one 
kind of salt requiring one thing, and a different one ano- 
ther. If the fever proceeded from viscid humours, diluting 
drinks were the specific antidotes. And much profound 
reasoning and acute argument were introduced into their 
discourses to prove the truth of their doctrine. "The 
high colour of the urine in fever," says Etmuller, "must 
need proceed from a prutrescent acid, for alkalies give a 
contrary tincture. Immoderate use of wine produces the 
same symptoms as fever, by means of its acid tartarous 
parts." In another place he remarks, "the slow fevers dif- 
fer from the acute oiks in this ; that the cause of the latter 
is a volatile sharp acid, which in the former is enveloped 
in a viscid vehicle." Burserius speaking of the acrimonies 
in fever, says, "according to the different nature of each, 
peculiar medicines must be employed to oppose the parti- 
cular kind of acrimony and lentor. In general the most 
proper are diluent watery drinks, gently resolving, attenu- 
ent, opening, but of the milder kind ; with which it is pro- 
per to mix acids, both vegetable and mineral, especially if 
heat is to be moderated, or a tendency to putrefaction pre- 
vented. For it appears that they are both wonderfully re- 
frigerent and antistptic, whether they produce this effect 
by blunting the sensibility of the nerves, and checking the 
sensibility of the fibres ; or by changing and saturating the 
volatile alkaline salts ; or by attracting and uniting with 
the inflammable principle, or in other words, the plogis- 
tion ; or by condensing the fibres and humours, or in all 
these ways, is of no great consequence."^ 

Oxymel was a common prescription with Hippocrates. 

The benefit derived from the use of the iuices of fruits 
is owing to the acid which enters into their composition; for 
it appears that all those juices of fruits which undergo the 
vinous fermentation, either with or without the addition 
of sugar, contain an acid.f 

Avicenna speaks of the benefit derived from the use of 
pomegranates and ripeplumbs, and particularly recommends* 
the watermelon.^ 

Galen also recommends in fever, such fruits as are of 
easy, digestion. jj He also informs us in another place that 

* Institutes of the Practice of Medicine, bv John Barest BurserioS, 
Yol. I. p. 163. 

j- Thompson's Chemistry. 

4 Opera Venet. cle Feb! C. xxxviii. 

«De Glauc, 1. i. C. ix. 



Cure of Fever. 35 3 

those who are set to watch the vineyards, and live for two 
months on grapes and figs become fat and hearty. 1 * 

Alexander Tralianus extols with admiration the cures 
he had performed in fevers with ripe fruits, such as peach- 
es, grapes and water-mellons, and which he found of the 
greatest efficacy in promoting perspiration, and effecting a 
discharge of acrimonious bile from the bowels. f 

Ripe fruits were a favorite remedy with Aretus. Among 
the advocates of the same treatment we may mention Ri- 
verius, Forestus, Fracastorius, Mercatus, Zacutus, Minder- 
erus, and Lucitanus. 

As long ago as the tenth century acids were prescribed 
by Rhazes to prevent the plague. 

Vinegar has been long celebrated as a remedy in fevers, 
both externally and internally employed, and considered as 
a powerful opposer of contagion. 

Diemerbroeck recommend? a few tea-spoonfuls of vine- 
gar to be taken in the morning, fasting ; and Sylvius says 
he prescribed it with advantage. His prescription employ- 
ed for external u^e received the denomination of the three 
thieve vinegar. 

The ancients considered the internal use of vegetable 
acids not only as a valuable remedy in fevers, but also as a 
wholesome beverage in health, and a preventive of malig- 
nant diseases. Thus the Roman soldiers were furnished 
with a daily allowance of vinegar, which was mixed with 
water for a common drink ; sometimes thin acid wine was 
allowed instead of vinegar. The moderns, however, in this, 
as in many other particulars, have refined upon the ancients, 
and in place of this wholesome beverage, have substituted 
whiskey and other preparations of ardent spirits, which so 
far from acting as preservatives, may be considered the bane 
and corruptors of temperance, morality and health. 

It is observed by Hoffman that of all the remedies that 
have been employed in the plague, none have been found 
more useful than acids. 

It is said of Boerhaave that in some cases of putrid fe- 
vers, he successfully ordered ten pounds of cherries daily. 
And his commentator, Van Sweeten,^: says, "the juice of 
ripe fruits requires no preparation, extinguishes thirst, tem- 
pers heat, opens the belly and urinary passages, and furnish- 
es the most exquisite solace to the stomach oppressed with 
putrid bile." 

* I)e Alim. Facult. 1. ii, et ix. f Lib. xi ; i. c. vi 

% Van Swcrteu Sec. 83. Ii. p. 126. 

$2 



354- Cure of Fever. 

" The juices of citron and sorrel," says Senertus, "resist 
putrefaction, peculiarly strengthen the heart, correct the 
feverish habit, and have apperient powers at the same time." 5 * 

We are informed by Mr. Cleghorn that the persons ap- 
pointed to watch the vineyards in the island of Minorca, 
from eating the ripe fruit, commonly continue in good health, 
though at the same time tertians generally rage with the 
greatest violence. 

In the treatment of bilious fever, Dr. Tissot informs us 
that after the first evacuation he seldom prescribed any thing 
except strong lemonade, or a decoction of the roots of quick 
gra&s, with an addition of the expressed juice of common 
sorrel, f 

Dr. Fordyce, in his work on putrid and inflammatory fe- 
ver, praises in high terms the benefit derived from the juices 
of ripe fruits, and says that they are the best provision in 
putrid fevers, and that in the bilious dysentery they act like 
a charm. "Such (says he) are the virtues of the vegetable 
acids ; and when physicians discover by an early attention 
to the smell of the sweat, the urine or fceces, or a close ex- 
amination of the colour of the skin, tongue, he. a tendency 
to a putrid state, they cannot only cure many dangerous, but 
prevent many fatal diseases by such means. Decoctions or 
infusions of frumentacious substances, seasoned with sea- 
salt, cream of tartar drink, thin wine, juice of lemons, and 
plain vinegar, do all contribute largely to an immediate, and 
perhaps a lasting change of the corrupted juices. When 
the disease is not contagious nor the putrefaction extreme, 
the vegetable acids are generally sufficient ; and when no 
inconvenience is found from their use they may be given 
freely. It is a mistaken notion that they will produce the 
colic, or disagree when there already subsists one, as in pu- 
trid cases of colic we know that nothing proves a speedier 
cure. In a very putrid state of the juices the mineral acids 
are used with the greatest advantage. The muriatic has, 
with me, the preference, from the observations I have made 
of its effects. Applied to the fauces in the ulcerated and 
malignant sore throat, they prevent the putrefaction, and 
preserve the part from gangrene, or even stop its progress 
when already begun ; taken into the stomach, they excite 
appetite by correcting its juices ; for nothing palls it more 
than putrid matter lodged there. It is a fact well known, 
that they are very useful in dysentery ; I mean the bilious 

* Senert. de Feb. Lib. ii. cap. vii. p. 221. 

| History of the Bilious Epidemic Fever at Lausane m 1755, 



Cure of Fever. 35 5 

one so common in armies during the autumnal season, when 
they correct the corrupted fevers, and act as strong anti- 
sceptics, hindering the putrid process in the animal econo- 
my. Finally, the best writers and the most scientific prac» 
titioners are agreed about their great use in putrid fevers.* 

Ripe fruits, and particularly grapes, are recommended by 
Dr. Stock in the bilious fluxes of armies, and he considers 
the mineral acids mixed with opiates as possessing wonder- 
ful efficacy in that disease.! 

It is observed by Assalini, that some soldiers, on their 
return from Gaza, with a convoy, discovered at a distance 
a French soldier wandering amongst the sands, about two 
leagues from the fort ; they went up to him, and found him 
with a bundle of sorrel under his arm : the man had been 
attacked with the epidemic disease, called the plague, and 
during his delirium had run off from the hospital. During 
the fifteen days which followed he had taken no other nour- 
ishment than sorrel, and he recovered perfectly 4 

In typhus, Dr.Trotter recommends fruits, such as oranges, 
gooseberries, currents, raspberries, prunes, melons, &c. and 
remarkes that if they do not disorder the bowels, which 
they are apt to render too lax, they may be used ad libitum. § 

Dr. James Carmichael Smyth praises the efficacy of acids, 
particularly those of the mineral kingdom, exhibited both 
in the early and latter stages of malignant fevers, and con- 
siders them more remarkably serviceable in checking the 
tendency to extravasation and haemorrhage. " In the last 
stage of those fevers," says he, "joined with the bark, they 
seem to increase the power of the medicine in resisting the 
disposition to gangrene." 

Dr. Monro|| recommends ripe fruits in typhus fever, for 
the purpose, as he says, of correcting the tendency of the 
blood to putrefaction, being both grateful and refreshing to 
the sick ; and ought therefore, to make a part of their al- 
lowance. " I have seen," says he, " lemon juice made pal- 
atable by the addition of sugar, prove a most cordial anti- 
sceptic in this fever, either given in draughts of one, two, 
or more ounces, five or six times in the day, or mixed with 
the patient's common drink." 

The yellow fever prevailed at Caraccas, in South Ameri- 
ca, in October 1793, with great mortality, more especially 

* Fordyce on Putrid and Inflam. Fev. p. 158 and Seq. 

f Ann. Med. 

t Assalini on the Epidemic of Egypt, p, 67. 

§Med. Naut. Vol. I. p. 277. 

5 diseases of the Army, j>. 247. 



35b Cure of Fever. 

among the Spanish troops. Nearly all died who were treat- 
ed by the physicians. Recourse was finally had to the old 
women, who were successful in almost every case to which 
they were called. Their remedies were a liquor called na- 
rancado, (a species of lemonade,) and a tea made of a root 
called fistula. With these drinks they drenched their pa- 
tients for the first two or three days. They induced plen- 
tiful sweats.^ 

Nature, indeed, points out the utility of acids in fever, by 
the instinctive cravings of the patient ; and whilst animal 
food, one of the most pernicious articles in this disease, 
proves disagreeable and loathsome, all acids are found the 
most grateful and refreshing. 

It sometimes unfortunately happens, that from inflamma- 
tion or irritability of the stomach, the mineral acids, even 
\v T hen plentifully diluted, cannot be taken without producing 
pain and exciting vomiting. In such cases we must refrain 
from their employment; the same objection, however, rare- 
ly applies to the acids of the vegetable kingdom. 

Mindererus spirit, supersaturated with lime juice or vin- 
egar, with the addition of a small portion of laudanum, 
proves peculiarly efficacious as a diaphoretic, corrects and 
neutralises the bilious accumulations in the stomach and 
bowels, and promotes their expulsion. 

The vulgar and prevalent opinion with regard to fruits 
in the supposed tendency which they produce in the system 
to fevers and dysentery is entirely without foundation. 
These remedies are pointed out by nature, and instinct 
teaches us to make use of them. Though they may excite 
the alvine evacuations, yet this is so far from proving in- 
jurious, that it is one of their most valuable properties. 
For by correcting and decomposing the bile they counter- 
act and destroy its morbific quality ; and by forming a kind 
of neutral mixture they act as mild cathartics, and promote 
the expulsion of offending matters. Every person who has 
had experience in the fevers of hot and tropical climates 
must be convinced of the necessity of keeping the bowels 
regular and free during the summer and autumn; and if 
this can be done without the aid of medicine we gain an 
advantage of the first importance. And what means so 
simple can more effectually answer the purposes and suit 
the necessities of the animal economy, during this insalu- 
brious season, than the use of the same provision and anti- 
dotes to disease which nature affords us in the vegetable 



* Rush's Inq. and Obs, V^l. III. p. 315. 



Cure of Fever. 357 

kingdom ? And how worthy of condemnation is that ab- 
surd and unnatural opinion, which, with ill-judged kind- 
ness, would prohibit the very remedies which Pro", idence 
has furnished for our health and comfort? Wherein do 
we most discover the wisdom and benevolence of superin- 
tending goodness? Is it in presuming the prohibition of 
the enjoyment of that plenty which his own bounty has 
provided, and in supposing that the fruits that load the 
branches and the vine are but tantalizing temptations, plea- 
sant to the eye, sweet to the taste but poisonous in their 
enjoyment? Or is it in following the precepts of experi- 
ence, and receiving as blessings in their season the fruits 
and productions of the vegetable world? A restriction, 
the breach of which expelled our father Adam from the 
bowers of Eden, is not now entailed upon his children. 
The orange and the apple are no longer presented to the 
view as prohibited enjoyments, to tempt the eye and dis- 
appoint desire, but for our use and welfare are they new- 
relished and matured. 

The great utility of acids in the cure of fevers remains 
yet to be more generally known and understood by their 
more extensive and liberal employment, not as palliatives 
merely, but as the chief and essential remedy in the cure 
of fever. Taken, as they usually are, merely to render 
the patient's drink more agreeable, but little benefit can be 
expected from them. But let them be exhibited as reme- 
dies capable of purifying the contaminated fluids of the 
body, in quantity proportionate to the malignancy of the 
disorder, and an improvement in the treatment of fever 
will take place as great as that which succeeded to the hot 
and sweating regimen in the treatment of small-pox. This 
is not a matter of mere speculation, a doctrine advanced 
solely with a view of supporting a favorite opinion. I ap- 
peal to experience, by which the utility and importance of 
these remedies in the treatment of fever is fully confirmed, 
even when given with a sparing hand, and without any 
particular object in their exhibition, except that of allaying 
the thirst and gratifying the taste of the patient. 

The natives of many eastern countries cure their patients 
laboring under fever, by the liberal, and what we should 
call the excessive use of lime-juice alone. 

Some few years since the attention of the faculty of Eu- 
rope was drawn to the more attentive consideration of this 
subject from the extraordinary success of Professor Reich, 
of Erlangen, in the treatment of fever with the mineral 
acids. Sale, Fretze, Richter and, Fourny were appointed 



358 Cure of Fever, 

a committee, under whose inspection Dr. Reich administer- 
ed his remedies to twenty-eight patients in the (Charite ; of 
these, twenty-three recovered, three refused to take the 
medicine and two died. For making known this valuable 
remedy a very considerable pension was granted to Profes- 
sor Reich by the King of Prussia. Dr. Reich informs us 
that in cases of extreme danger and malignancy one or two 
drachms of the muriatic acid may be given at once. The 
oxygenated muriatic acid may be employed with the same 
view. "I, at first," says the Professor, "for a long time 
made use of the sulphuric acid, but finding that it was not 
relished by the sick, that it did not part with its oxygen 
quick enough, and that it often felt heavy in the stomach, 
I made trial of the common muriatic acid, and this proved 
in the result, to be one of the best and most pleasant acids. 
I have, since that, constantly made use of it. Besides these 
two mentioned acids, I have made use of others, and found 
their operation coincide with my opinion." Dr. Reich 
thinks well of the phosphoric acid, but is apprehensive of 
the hurtful effects of the nitric in 1 some of its forms. 

Why so valuable an improvement has been so much ne- 
glected, we can only account for by ascribing it to that 
pride of individual opinion, which looks with jealousy and 
distrust upon the superior claims, pretensions and discove- 
ries of others, and to that prejudice in favor of received 
and antiquated dogmas, which would rather cherish an an- 
tedeluvian error than embrace a modern truth. The 
nitric and muriatic acids were employed with decided bene- 
fit, especially in cases marked with malignant or typhoid 
symptoms in the endemic fever of Alabama in 1821 — 22 
and 23, they were also given as tonics in the advanced 
stage of the disease, and during the period of convales- 
cence.^ 

The vitriolic, or sulphuric acid was long since known as 
a useful remedy, and is highly recommended by Riverius 
and Sydenham for allaying febrile heat and thirst, abating 
inflammation, resisting putrefaction, and checking haemorrh- 
age ; and we are told by Sydenham that he chiefly depend- 
ed upon this medicine for moderating the eruptive fever in 
the confluent small-pox. It is well known that the mineral 
acids, and particularly the nitric has been used with the 
most signal success in the cure of syphilis, even in those 

*The reader will find an interesting" case of the successful employment 
of nitric acid in bilious fever, related by Dr. Isaac Auld, of South Carol: > 



Cure of Fever. GJ9 

cases where mercury had failed. We know not by what 
peculiarity morbid poisons differ from each other, so as to 
vary their effects in the developement of their individual 
and specific symptoms. But however diversified in appear- 
ances the presumption is, that the morbid poisons of all 
malignant diseases are analagous in their chemical and con- 
stituent principles. Thus the various forms of the exan- 
themata, as the small pox, chicken pox, French pox, &c. all 
summer and autumnal fevers, arising from putrefaction, the 
different denominations of typhus, ship, jail and hospital fe- 
vers, in fine all fevers, except the simple continued or in- 
flammatory fever, arising from suppressed perspiration, pro- 
bably originate from modifications of the same cause, and 
require a similarity of practice in their prevention and cure. 

Dr. Ferrier of Manchester has found the nitrous acid ve- 
ry useful in the latter stages of typhus, when the Peruvian 
bark disagrees, or when the patient will not take bark or 
wine. He gives one and an half drachm three times a day.^ 5 

Mr. Snipe, Surgeon of the Sandwich, ascribes the success, 
in subduing a contagious fever, which raged on board that 
ship, to "cleanliness, free ventilation, and the diffusion 
daily of nitrous acid gas through every part of the ship."| 

Mr. Farquhar, of the Theseus, found the nitrous acid va- 
pour to destroy the smell proceeding from putrid ulcers. i 

In the treatment of fever I have found the carbonic acid 
gas of the greatest benefit. It subdues the vomiting, allays 
the irritability of the stomach, and enables it to retain the 
necessary remedies received. But as it is difficult to exhi- 
bit this article by itself, the mixture of a vegetable acid and 
an alkali, as the carbonate of soda or potash with lime 
juice or good strong vinegar, affords an excellent prescrip- 
tion. From ten to twenty grains of the carbonate of soda 
or potash may be mixed with nearly half a wine glass of 
lime-juice, the soda being seperately dissolved in a little 
water, and the lime-juice rendered more agreeable by the 
addition of refined sugar, and then being suddenly poured 
together they should be taken in the act of effervescence. 
The soda or seidlitz powders of the shops as they came 
prepared, are, perhaps, as good preparations of the kind 
as can be employed. I have generally prescribed them, 
and have found them very beneficial. To avoid oppressing 
the stomach, the papers should be divided into two or three 
portions, and mixed and taken as the carbonate of soda 

* Dune. Ann. of Med. Vol. IV. p: 46, 
f Smyth on Nitrous Vapour, p. 202. 
t Smyth on the Fa.H Distemper, p. 2] r 



S60 Cure of Fever. 

and lime-juice. This prescription is calculated to answer 
several useful purposes : the carbonic acid, thus received, is 
grateful and cooling to the stomach, and is a corrector of 
the v itiated fluids of the prima? via? ; whilst the neutral salt, 
formed by the combination of the acid and the alkali, acts 
as a diuretic and diaphoretic, and keeps up the action of the 
bowels. 

The saponaceous and alkaline quality of. the bile has been 
already noticed, as likewise the redundancy *of this fluid in 
endemic fever, and from the chemical action of acids in 
decomposing the bile, as already observed, their great util- 
ity in this respect alone, in the fevers of hot and tropical 
climates, must be sufficiently manifest. I have found when- 
ever there was a great redundancy of bile, as indicated by 
a jaundice color of the skin and eyes, thick and yellow 
urine, tinged and abounding with bilious matter, muriatic 
acid was exhibited with the best effect. By neutralizing 
and destroying the bile, and also by correcting that state of 
the fluids disposing to its redundant secretion, it restored 
the healthy color of the urine, removed the yellowness from 
the skin, and subdued the lurking fever. 

For allaying the irritability of the stomach the applica- 
tion of a blistering plaister to the epigastrium, as before 
directed^ will often be found of considerable advantage. 
At other times hot fomentations with water, and spirits, 
impregnated with camphor and opium may be applied to 
the region of this organ. I have also found considerable 
relief from a mixture of elixor vitriol, with the oil of cin- 
namon and spirits of peppermint; and on some occasions 
I have known a dose of calomel with a grain of opium give 
an immediate check to the vomiting and irritation. Should 
these fail, a small injection of warm water with eighty or 
a hundred drops of laudanum may be given with a pros- 
pect of success. Equal parts of lime-water and milk have 
sometimes been given with the best effects in restraining 
the vomiting and allaying the irritability of the stomach. 
Milk alone, has often been successfully exhibited in violent 
attacks of the cholera-morbus. For the purpose of allay- 
ing the vomiting, Dr. Rush prescribed in the yellow-fever 
of Philadelphia, a table-spoon full of sweet milk every hour, 
or small draughts of milk and water; which he represents 
as superior to any other remedy.* For the same purpose 
Dr. Blane recommends magnesia and mint water. f For the 

* Rush's Inq. and Obs. Vol. HI. p. 28?, 
t Diseases or' Seainen, p. 452, 



Cure of Fever. 361 

distressing vomiting occuring in the second stage of fever, 
Dr. Physic, Dr. Church and others gave, in the yellow fever 
of Philadelphia in 1805, the spirits of turpentine with great 
success, in the quantity of ten drops in a little molasses, 
syrup, or sweet oil, every two hours. * 

For restraining hiccup the nitric acid diluted, a draught 
of wine, or cold water, raising the patient to an erect posi- 
tion for a few moments, will all occasionally afford a tem- 
porary relief. 

In persons of slender and delicate constitutions, a cough 
sometimes continues or supervenes after the disappearance 
of the fever. As this symptom proceeds mostly from de- 
bility and irritation, without any inflammation or settled 
organic disease, tonics, as vegetable bitters and wine will 
be found its best remedies. And it is a remark made by 
the sagacious Sydenham, that the best remedy for a cough, 
after a fever, is rich nourishing wine. When the cough is 
more inveterate I have prescribed tar- water and syrup of 
hoar-hound with the best effect. The tar-water is directed 
to be taken as a constant drink. 

Many physicians in the treatment of fever, are in the 
habit of using considerable quantities of opium. From my 
own experience, I am induced to think that their represen- 
tations of its utility are much exagerated. When fever is 
present I have always found it injurious when given alone, 
by agravating the symptoms ; if on other occasions it pro- 
cures sleep, this is disturbed and unrefreshing, the patient's 
mind is stupified, deranged and bewildered; frightful dreams 
and incubus terrify his slumbers, and he recovers from the 
stupifying effects of this narcotic, languid, sick, and feverish. 
If given in the absence of the fever, it is still exceptionable : 
and one hour of natural sleep is more refreshing and ser- 
viceable to the patient than half a dozen of forced slumber, 
obtained by the use of opium. Independent of its debili- 
tating effects, a very material objection to this drug is that 
it corstipates the bowels. I speak here of the employment 
of opium as an anodyne, without being combined with 
other articles to obviate its injurious effects. When given 
in small quantities and in combination with other medicines, 
as in the preparation of Dover's powders, or with calomel, 
antimonial powder and nitre, it aids the operation of the 
compound, and may some times prove serviceable as an 
anodyne and diaphoretic. But as the powers of opium 
alone as a diaphoretic are limited and uncertain, it should 

* Diseases of seamen p. 4*2, 

w2 



■3'6& Cure of Fever. 

never be given when the fever is present, except in combi-" 
nation with other articles, as in the above prescriptions. 
Where the patient is free from fever, but languid and debi* 
litated, and wherever stimulants are required wine will be 
found the best anodyne. 

The principle view with which opium can be given in 
fever with advantage is to prevent the return of expected 
paroxysms. With-.this intention I have frequently prescri- 
bed it in fevers both of the intermitting and remitting type, 
when unattended with symptoms of malignity, in the man- 
ner pointed but when treating of the cure of intermitting 
fever. Where much nervous irritation prevails, with little 
or no fever, and the patient is exhausted for want of sleep, 
a dose of opium may be given with advantage. 

Where the remitting assumes, as it often does the inter- 
mitting form, it of course should be treated in the mode re- 
quired by the latter; and vice versa, when ague and fe<er 
changes to the remitting fever a corresponding change will 
be required in the treatment. 

In managing the regimen of febrile patients cleanliness 
and ventilation are highly necessary to be observed. The 
patient's bed and body linen should be frequently changed ; 
clothing that has been much wet by perspiration should be 
removed at least once in twenty-four hours. The room 
should be kept free and clean from all excrementitious mat- 
ters voided by the patient. The apartment should be kept 
as clean as possible ; the walls should be divested of old 
clothes and garments, and all unnecessary furniture should 
be removed from the patient's chamber. During the day 
the windows and doors should be kept open, in such a way 
as to exclude the sun and admit the air. The apartment 
should be frequently sprinkled with vinegar, or fumigated 
with vinegar poured upon a hot brick or shovel, which pu- 
rifies and refreshes the air, and has the effect in some de- 
gree of correcting and destroying infection. 

If, upon the invasion of the fever the patient could be 
conveniently removed in a litter, or some easy mode of 
conveyance to an airy and healthy place, within a short dis- 
tance, his cure would be much facilitated. The advantage 
of wholesome air is of immense benefit in facilitating the 
recovery of a febrile patient. In illustration of this subject 
I will subjoin the following facts. The first is from a cor- 
respondent of Dr. Lind's who had resided a long time in 
the Island of Jamaica. "I have often seen," says he, "the 
poor seamen in the merchant service to recover from the 
yellow fever solely by having the benefit of a free and con- 



Gure of Fever. §6$ 

.S-tant admission of the cool sea air, into a ship anchored at 
a distance from the shore, where they lay utterly destitute 
of every assistance in sickness, and even of common neces- 
saries, having nothing but cold water to drink, and not so 
much as a bed to lie upon : while gentlemen newly arrived 
from England, by being shut up in small, close, suffocating 
chambers at Kingston and Port Royal, expired with the 
whole mass of blood dissolved, flowing from every pore ; 
the stifling heat of their room having produced a state of 
universal putrefaction in the body, even before death. "* 

Palloni, in his Essay on the Yellow Fever of Leghorn 
in 1804, speaking of the advantage of pure air in the pre- 
vention and cure of this disease, makes the following ob- 
servations. " Those who remove from the country where it 
prevails, if they were not sick at the time of their departure, 
the seeds of disease are not generally unfolded, as they 
seem in such cases to be corrected or destroyed by the 
change of air and situation. But there can be no stronger 
or more cogent argument in favor of the usefulness of pure 
fresh and renewed air in this disease, than the happy expe- 
rience of its efficacy in the new hospital of St. James. Sit- 
uated, as it were on the margin of the sea, remote from the 
unwholesome vapors of the tower, and exposed to the free 
access of the purest air, which, by reason of its construc- 
tion and disposition, can act upon it to the utmost advan- 
tage ; it is well worthy of remark, that it was scarcely open 
for the reception of the sick, than from that moment the vi- 
olence of the disease began to abate in the city, and a great 
proportion of the destined victims were snatched from death. 
It was wonderful to behold the wretched sufferers taken 
from their houses, debilitated, oppressed and as it were o- 
vercome with illness, who were no sooner lodged in the new 
assylum, than the vital principle appeared to be renewed in 
an instant ; they revived ; they declared that a sensation of 
well being succeeded to anguish and depression, and the 
distemper immediately assuming a milder form, yielded to 
art, and a suitable plan of treatment was at once adopted. 
In a short time the sick recovered from a short and easy 
convalescence." 

* Lind on the Biseases incidental to Europeans in hot climates. 



3)54 Convalescence. 



CCWVALESCENCE. 

In the northern states and in heatthy countries, the sys~ : 
tern soon resumes its former strength after an attack of sick- 
ness. The unassisted powers of nature and a salubrious 
atmosphere speedily restore the lost vogor of the constitu- 
tion, without the aid of medical prescription. Not so in 
unhealthy climates and situations. The frame is here left 
weak and languid from disease, and upon emerging from 
the confinement of a sick bed, the invalid is again exposed 
to the operation of the same morbific causes which occa- 
sioned his previous disorder. Every breath he draws is 
impregnated with the principles of disease, and a sultry cli- 
mate still continues to relax and enervate the frame. Un- 
der these circumstances, therefore, it is not surprising that 
persons are subject to repeated attacks of fever during the 
same season. Indeed, it rarely happens that a person who 
has been seriously ill recovers even a comfortable share of 
health, till the ensuing winter; and frequently he is subject 
to renewed attacks of intermitting fever, or as it is called 
chills and fevers till the return of the succeeding season. 

In guarding against these relapses, much will depend up- 
on the habits of temperance and regularity in the person ; 
avoiding late hours, exposure to the sun, rain and night air ; 
observing temperance in eating, always stopping short of 
satiating the cravings of appetite ; refraining from animal 
food, except in very small quantities, and using it only once 
a day ; selecting vegetables of easy digestion ; eating light 
and abstemious suppers. In addition to all which, the use 
of the cold bath will be found highly invigorating ; to per- 
sons, however, of very delicate constitutions it would be in- 
admissible. 

As the body, in consequence of previous disease, is left 
in a relaxed and debilitated state, persons upon recovering 
from fever are apt to be attacked with profuse sweats, par- 
ticularly in the night, during the repose and sleep of the 
body. Such colliquative sweats are debilitating and ex- 
hausting to the enfeebled constitution. The most useful 
remedies for this complaint will be found in bark, wine, 
elixir of vitriol and the cold bath. 

Under all circumstances of debility, the use of Peruvian 
bark, two or three times a day, will be found useful ; and 
when the body is much enfeebled, and subject to returns of 
fever in the evening, bark and wine will be found of the 



Convalescence, 365 

most essential benefit. In place of the bark, vegetable bit- 
ters, as quassia, gentian, columbo and snake root in decoc- 
tion, with the addition of a moderate quantity of wine, may 
be used with advantage when the returns of fever do not 
require the continued use of the bark. Where the bark 
cannot be taken in substance it may be used in decoction 
or infusion with cinnamon, cloves, or any other aromatic 
that may be most agreeable to the patient. 

Keeping the bowels free and regular is_ also of great im- 
portance in convalescence from fever, and if the person is 
disposed to constipation, the best effects will be derived from 
the tincture of aloes and rhubarb ; or a portion of rhubarb, 
sufficient for the purpose, may be added to the bitters above 
directed. Persons subject to constipation may also chew a 
piece of rhubarb root at night before going to bed, so as to 
operate on the following morning.^ 

By observing the forgoing directions most of the acci- 
dents and returns of disease to which convalescents are lia- 
ble would be prevented. But many persons in recovering 
from fever are deaf to the voice of instruction and advice. 
With keen and morbid hunger, created by the emaciation 
of the body and the empty state of the vascular system, they 
sit down to the table, and fill themselves with an excessive 
and uncomfortable load of whatever is most agreeable to 
the cravings of a voracious appetite. The consequence is 
that the stomach is unable to digest the crude and hetero- 
geneous mass, which undergoes a partial fermentation ; the 
stomach and bowels become inflated and distended with air ; 
irritation is produced ; and fever is excited. It is vain to 
suppose that the body will be strengthened by the indul- 
gence of the appetite and by overfeeding ; the food, to prove 
nutritious must be well digested, and it is impossible that 
this can take place where the quantity of aliment received 
is too great, and disproportionate to the powers of the di- 
gestive organs. Where the stomach is weak the quantity 
of food should be small and of easy digestion. Hot drinks, 



*The following formula will be found beneficial, both as a preventive of 
fever and a tonic aperient for invalids and convalescents : 
Takt Aloes two drams, Rhubarb two ounces, 

Chamomile flowers, Canella Alba one ounce, 

Gentian, Spirits two quarts. 

Orange peel, each one ounce. 
After standing four days it is fit for use. From half an ounce to an ounce 
of the tincture may be taken diluted with water, every morning, or as 
much oftener as the state of the bowels require. It is of importance that 
the person should have one or tvyo free evacuations every twenty-four 
hours. 



36£ Convalescence 

and all fat and greasy articles of diet should be carefully 
avoided. Nourishment may be taken often, but in a small 
quantity at a time. 

When the patient is labouring under a fever we need 
have but little solicitude about his eating ; for in this situ- 
ation all nourishment received will but oppress the stomach, 
and aiford support and fuel to the fever. But after the fe- 
ver has come to a crisis, and convalescence is established, 
the body is in need of nourishment, which, however, must 
be taken in moderation, and should not be of a heating and 
stimulating kind. The teeth are the servants of the stom- 
ach, it is by them that the aliments are fitted, by comminu- 
tion and being blended with the saliva, to undergo diges- 
tion ; invalids, therefore, cannot be too careful in the delib- 
erate and perfect mastication of their food. Parents and 
friends are apt to think that provided a person can eat there 
is no danger : and as eating is necessary to preserve the 
strength of those in health, the same rule is applied to sick- 
ness and indisposition, without any allowance being made 
for the change which has taken place in the system. Such 
notions, as they are founded in ignorance and error, so are 
they dangerous and hurtful in their tendency. The stom- 
ach, generally speaking, is the monitor and judge of its own 
necessities ; I say generally ; for where persons, especially 
those of delicate habits have undergone much fatigue, from 
any sudden, violent, or long continued exertion, the stomach 
partakes of the temporary exhaustion, and loss of appetite 
is the consequence : here a little nourishment is not only 
admissible but useful ; and a biscuit with a glass of wine 
and water will be found refreshing" But in that state of 
predisposition to fever, created by languor, fatigue and list- 
lessness, a feverish habit, head ache and want of appetite, 
food is not only loathsome but injurious. It is in vain for 
the person to think of overcoming his feelings of indisposi- 
tion and debility by forcing his stomach to receive the ne- 
cessary sustenance of health. The digestive organs have 
lost their power, the gastic fluid, the main agent in diges- 
tion is changed from its healthy state ; and what is eaten 
under these circumstances is no longer nutritious, but lies 
with a heavy and oppressive weight upon the stomach, in- 
creasing the general uneasiness, and kindling the latent em- 
bers of disease. The danger in patients laboring under fe- 
ver is not in eating enough, but in eating too much. Dilu- 
ents, however, such as cooling acidulated drinks may be 
taken freely ; the pulp of ripe and mellow fruits may like- 
wise be eaten ; and as a nourishment for convalescents and 



Convalescence. . 367 

for patients during the recess of the fever, gruel, and vege- 
tables of easy digestion may be used. But the invalid 
should avoid salted meats, and touch very lightly upon ani- 
mal food of any description.* Cucumbers, musk mellons, 
and all unripe fruits, as being heavy and difficult of diges- 
tion should be avoided ; also tough, stringy and fibrous 
vegetables. 

Much has been said both for arid against the use of milk 
in fever both by ancient and modern physicians. The opin- 
ion of Hippocrates on this subject, as on many others, I con- 
ceive to be founded on experience and truth. "It is bad," 
(says he) to give milk in head ache. It is also bad to give 
milk in a fever, as likewise to those who are thirsty and 
troubled with flatulence, it is prejudicial where there are 
bilious stools or acute fevers. "j Sweet milk is particularly 
objectionable in fever. As the stomach is weak, the func- 
tion of digestion is but imperfectly performed : and it is 
well known that fresh milk, upon being received into the 
stomach is immediately coagulated by the action of the gas- 
tric fluid and converted into cheese ; in which state it lies 
as a heavy indigestible load upon the stomach, producing 
heat, irritation and fever, and after being imperfectly diges- 
ted furnishes nutriment for the bile, and food for the disease. 
Clabber, whey and butter-milk, having been robbed, in a 
considerable degree of their rich and oily portion, and hav- 
ing lost the property of being converted into cheese by the 
action of the gastric fluid, are less objectionable than sweet 
milk, and appear to be the only forms of this article that 
can be used with impunity in fever. Riding on horse back 
in the cool of the day, or in the shade, is a wholesome and 
invigorating remedy. In using exercise, however, of all 
kinds, care should be taken not to carry it to the point of 
inducing much fatigue, otherwise its good effects will be 



* Si febricanti quis cibum exhibuerit, sine quidem robor, et aegrotanti 
morbus. Hlppoc. .flpk. 67, Sec. 7. Dr. Huxham, speaking- of the epi- 
demic fever of June 1740 says, "If any one made use of flesh or fish diet, 
unless he had been very well purged, and his recovery confirmed, he in- 
fallibly indulged himself herein at the utmost danger of his life ; nor did 
he often run a less risk from a more rough cathartic." Huxham on Epi- 
demicsVol. 1, p. 67. "Solid animal food," says Dr. Fordyce, "even such 
as is of the easiest digestion, such as fowls and white fish of a moderate 
degree of firmness, as whitings, have been the cause of the greatest num- 
ber of relapses when used after a crisis, or by a convalescent, that have 
come Within the knowledge of the author. "Fordyce on Fever, Vol. 2 Of 
Regular Continued Fever pari 1, p. .100, The injurious effects or ani- 
mal food in eonv descents from yellow fever was observed bv Dr. Bush 
in the epidemic of Philadelphia in. 1797, 

+ Hippoc. Lib, 5, Jiph. 64, 



368 j, Convalescent?. 

counteracted ; nor should any be attempted which required 
much exertion. The patient should confine himself mostly 
to the house till his health and strength are in some degree 
restored. 

Persons who have suffered attacks of the bilious remit- 
tent, are often subject to a lingering and tedious convales- 
cence ; or in other words, remain in an infirm valetudinary 
state for a considerable length of time, for weeks, and even 
for months, during which they are from time to time sub- 
ject to irregular attacks of fever, chills and fevers, and of 
fever and ague ; the types frequently changing and inter- 
changing their forms. In this situation the patient should 
take daily, during the intervals of the fever, some vegetable 
tonic ; of these the bark is, generally the most useful ; though 
on many occasions I have found a mixture of bitters and 
aromatics to succeed where the Peruvian bark has failed.^: 
The bark should be taken as already directed. The chills 
and fevers, as they are called, may also be prevented by 
taking the diffusible stimuli, as opium, laudanum, paragoric, 
he. (as already pointed out under the cure of intermittent 
fever) about an hour before the period of accession, when 
this is known. In addition to the use of vegetable bitters, 
where there is considerable debility, with a luecophlegmat- 
ic habit and a disposition to dropsical affections of the ex- 
tremities, the muriated tincture of iron, in the quantity of 
fifteen or twenty drops, three times a day, may be exhibited 
with the best effect. 

* The prescription I make use of on these occasions is as follows : 
Take of Quassia, Gentian, 

Virginia Snake Root, Columbo, each half an ounce, 

Canella Alba, 

Flowers Chamomile, each two drams. 
Boil the ingredients tog-ether, moderately for half an hour, in three 
pints of water ; decant when cold, add tw6 gills of spirits, and keep the 
decoction in a bottle or bottles, well stopped. Of this the patient or in- 
valid is directed to take a wine glass full fiye or six times a day. 



AN ACCOUNT 

OF THE 

BILIOUS REMITTING OR ENDEMIC FEVER 
OF ALABAMA, 

AS IT APPEARED IN CAHAWBA AND ITS VICINITY 

IN THE 

Summer and Autumn of 1%2!, 



/uY ACCOUNT, &fe. 



Upon taking a survey of the circumstances which ac- 
companied this wide spread malady, we are forcibly remind- 
ed of the causes which have been enumerated in a preced- 
ing part of this work ; and their influence in the produc- 
tion of disease is strikingly exemplified in the instance now 
under consideration. 

Heat and moisture have already been considered as essen- 
tial causes in producing a vitiated state of the atmosphere, 
and in the consequent generation of endemic fever. With 
a knowledge of this fact before us, we need not wander far 
in quest of an explanation of the origin and propagation o£ 
this extensive calamity. 

The quantity of rain that fell late in the spring and dur- 
ing a very considerable part of the summer moaths was al- 
most unprecedented in the recollection of the oldest inhab- 
itants. The low grounds and swamps adjacent to the Ala- 
bama and the Cahawba rivers were frequently inundated 
during the early' part of the season ; so that it was late in 
May before many of the farmers on the rivers had an op- 
portunity of planting, owing to the highness of the water. 
A considerable fresh or rise of the river took place in July^ 
and such was the quantity of rain that fell early in the sum- 
mer that many of the farmers were entirely frustrated in 
their attempts at planting ; the earth being so completely 
wet and inundated that the seed rotted in the ground ; so 
that many were obliged to plant the same field three or four 
times ; and then, in several instances, were doomed to lose 
their labor, and abandoned the undertaking as hopeless. — ■ 
The same excessive quantity of rain appears to have given 
origin to an infinite generation of worms, which, by seizing 
upon the small remains of the crop that the rain had suf- 
fered to vegetate, made clean the work of destruction. — 
Such, indeed was the situation of affairs, in many instances, 
upon the river ; in others, less injury was sustained, and 
upon the uplands, remote from the river, the crops came 
forward with considerable certainty and success. Even 
there, however, crops of corn and cotton were injured by 
the excessive rains, and replanting became a business m. 
equal necessity. 



<372 Bilious Remitting or Endemic Fever of 1821. 

This peculiarity in the wetness of the season appears not 
to have been confined to Alabama, but extended generally 
through the southern states ; committing waste and de- 
struction during its continuance, and depositing the seeds 
of an infinite progeny of diseases. 

The 2k\ erage range of the thermometer during the month 
of June was, at 7, A. M. 73°— 2, P. M. 85% and at 9, P. 
M. 77°. 

During the same month in Philadelphia, in 1793, the av- 
erage range of the mercury in Farenheit's thermometer was 
at 7, P. M. 66°, and at 2, P. M. 77° 

Throughout the month of July, the average temperature, 
as indicated by the same thermometer was at 6, A. M. 71% 
at 3, P. M. 84% and at 9, P. M. 75°; making a mean tem- 
perature through the day and night of 76^°. 

During the same month in Philadelphia in the fatal year 
of 1793, the average range of the mercury in the thermom- 
eter at 6, A. M- was 71% and at 3, P. M. 80°. 

During the prevalence of the yellow fe^er in New-York 
in 1795, the average range of the thermometer in June was 
at 8, A. M. 66% at 1, P. M. 74% and at 6, P. M. 66°. In 
July, at 8, A. M. 71% at 1, P. M. 77% and at 6, P. M. 78°. 
In August, at 8, A. M. 74% at 1, P. M. 80% and at 6, P.M. 
75°* 

During the sickly months of August, September and Oc- 
tober, my time was so much occupied in \ isiting the sick, 
that I was unable to register the state of the thermometer. 
Throughout the month of August, I should judge that the 
temperature of the weather was not below that of July ; nor 
was there any perceptible change until the latter part of 
September. We are informed by Dr. Hillary that in the 
island of Barbadoes the thermometer never falls below 70* 
in the coolest mornings, nor rises higher than 86° in the day 
time.j This may be considered inferior to the heat of the 
sumiv-er months in the state of Alabama, where I have fre- 
quently obser- ed the thermometer as high as 90 and 96° in 
the passage of a tolerably cool house 4 In the state of Ala- 

* See Webster's Collection of Papers on Bilious Fever. 

-j-OlI che Diseases of Barbadoes. 

tlf s worthy of remark thai the range of the mercury will be very ma* 
terially iv'luenced by the situation. Thus, in the same town there is of- 
ten a difference of several degrees in different thermometers. If the 
buikiiiyr is small, without ceiling- or plastering-, and not sheltered from 
the heat of the sun by the shade of trees, the thermometer will rise con- 
sideraMv higher in the heat of the day than it will in one that is well fin- 
ished, L g c-, airy and well shaded. So that <n judging of the temperature 
of a place it is necessary to understand the situation of the thermometer 



Jjilious Remitting or Endemic Fever of 1821. STS 

bama we certainly have a much longer continuance of hot wea- 
ther, as well as a higher range of temperature during the rum- 
mer months, than is found to prevail in the states of New- 
York and Pennsylvania. To this circumstance it is owing 
that the inhabitants of Alabama are more subject to sum- 
mer and autumnal diseases than those of the northern states. 

In addition to the usual causes of disorder which exist 
in some of the older states, the inhabitants of Alabama 
were exposed to those which are inseperable from the first 
settlement of a country. Much timber had been killed, and 
a considerable quantity of land brought suddenly into a 
partial state of cultivation. The consequence was that 
rauch vegetable matter was left to rot upon the surface of 
the earth, and the accumulated mould of ages was exposed 
to the action of the sun and air, without a sufficient quan- 
tity of plants and herbage to appropriate entirely to their 
nourishment and growth the otherwise noxious products of 
decomposition. Besides, from the floods of rain that had 
fallen during the earlier part of the season, a great quantity of 
decaying animal and vegetable substances was washed from 
the slopes and acclivities of the hills, and deposited in the 
adjacent low grounds and swamps. By long continued ma- 
ceration, this corruptible matter had become so softened and 
subdivided as to be operated upon with the greatest facility 
as soon as it should be exposed to the action of the sun and 
air. Accordingly towards the latter part of July, when the 
rains had measurably ceased, the water of the ponds and 
marshes considerably evaporated, and the river had fallen 
within its banks, the work of putrefaction went en with ra- 
pid strides, and disease began to make its appearance.— 
Curing the continuance of the rainy season the countrv was 
healthy ; but when the swamps and low grounds, which had 
been previously inundated, became exposed, decomposition 
was immediately excited in the offensive mass of moulder- 
ing materials, and the atmosphere was speedily contamina- 
ted. 

It may, perhaps, be laid down as a physical fact that the 
sickness of any situation subject to endemic fever, will be, 
in proportion to the quantity of rain and wetness of the 
spring, mid to the heat of the succeeding months. Thus, 
when the spring is dry and the summer cool we mav calcu- 
late upon a healthy season ; and on the contrary, when the 
spring is unusually rainy and the summer extremely warm, 
we can scarcely be mistaken m prognosticating the preva- 
lence of disease ; or should the spring and summer b 
continue dry, the season will be renerailv healthv. 



-374 Bilious Remitting or Endemic Fever o/'IS'Sl, 

In the month of August the putrefactive process had ari- 
sen to its height, and at this time, it was almost impossible 
to ride through the town or country, or turn a corner with- 
out being assailed by a disagreeable and noisome odour, re- 
sembling that of a sick room, where two or three patients 
are confined with the worst kind of bilious fever. This 
smell was most perceptible at the still and damp hour of 
twilight, when the morbific miasms, not being dispersed and 
scattered by the wind, were suffered to accumulate in the 
vicinity of the mouldering mass from which they originated, 
and by attaching themselves to the particles of the falling 
dew, diffused themselves in the atmosphere around. Of 
these mouldering ruins of animal and vegetable growth, and 
hot beds of disease, there was no scarcity. 

As the disease arose from natural causes, too extensive, 
perhaps, for human controul, so by a suspension of the same 
powerful energy, the evil was at last checked in its career t 
and mankind were again permitted to draw the breath of life 
without inhaling the seeds of pestilence and death. 

We know not to what degree the air which we breathe 
may be corrupted without endangering health, but that it 
may be so to a certain extent, there can be no doubt. Thus, 
decomposition takes place at a temperature considerably be- 
low that which is necessary for the production of bilious or 
yellow fever: and in every climate and country this pro- 
cess goes on to a greater or less extent during the summer 
months. Now, the natural effect of this decomposition is 
to vitiate the atmosphere ; yet in high northern latitudes the 
inhabitants remain perfectly healthy, at least, entirely free 
from any thing like the endemic fevers of hot and tropical 
climates. From which it appears that it is only when the 
aerial products of decomposition exist to excess in the atmos- 
phere that they become the source of derangement and dis- 
ease to man. Nor is our atmosphere ever entirely free 
from this impurity and the contamination of heterogeneous 
admixtures. 

There is a power inherent in the constitution, which the 
older physicians denominated vis medicatrix naturse, by 
whose agency they endeavored to explain every obscurity 
in physical investigation. This power it is that enables the 
system to resist, to a certain degree, the injurious tendency 
of hurtful impressions. Were it not for this inherent prin- 
ciple of preservation, life would be in continual danger. Poi- 
sons and deleterious substances, within certain bounds, 
are received into the stomach with impunity, and tainted 
air is breathed without infection. But there is a limit to 



Bilious Remitting or Endemic Fever of 1821. 375 

this salutary agency, beyond which nature, in vain, endea- 
vors to oppose resistance. So in the instance under con- 
sideration, the air had become highly charged with mias- 
#nata, and it was no longer in the power of the human con- 
stitution to withstand their morbific influence. 

Cases of intermittents and remittents, which yielded with 
facility, at first prevailed ; but a rapid increase in the viru- 
lence of the morbid poison soon produced a corresponding- 
aggravation in the malignancy of the symptoms ; so that it 
at length became clearly and satisfactorily established in 
my own mind, that it was completely in the power of a sim- 
ilar agency to that which gave rise to this disease, by an 
augmentation in the virulence of infection, to produce eve- 
ry symptom of the most fatal plague. 

That the atmosphere may be so vitiated as to produce 
instant death, numerous facts satisfactorily prove. And 
what might be the effect of absolute purity in this element 
in prolonging the term of human existence, we are unable 
clearly to determine. But that its influence, in this respect, 
would be very considerable, there can be no doubt. And 
though there are various causes by which the constitution 
is impaired, yet the healing influence of a salubrious atmos- 
phere, perfectly free from every impurity, might be suffi- 
cient to counteract the operation of other hurtful agents 
through a long succession of revolving years. 

Constitutional peculiarity had considerable influence in 
modifying the operation of physical causes. Thus the in- 
habitants who had migrated from unhealthy countries, as 
the Carolinians and Georgians, suffered comparatively little. 
Amongst persons from Tennessee and Kentucky, from the 
northern states, and from Europe, on the contrary, the dis- 
ease was peculiarly malignant. Thus it appears that a long 
familiarity with unwholesome smells and noxious exhala- 
tions renders the body, in a great degree, insensible to their 
presence. In illustration of which we are informed by Dr. 
Rush, that in the yellow fever which prevailed in Philadel- 
phia in 1793, out of nearly one hundred butchers who re- 
mained in the city, three only died with the disease ; and 
that out of forty scavengers who were employed in collect- 
ing and carrying away the dirt of the streets, only one was 
affected with the fever and died. 

According to my observation, the disease was less severe 
upon negroes than upon white people ; though the differ- 
ence in this respect was by no means so striking as has been 
observed by others. Thus, we are informed by Dr. Hunter, 
in his work on the diseases of the army in Jamaica, that 



$76 Bilious Remitting or Endemic Fever of 1821. 

scarce one in thirty of the soldiers sent out on the St. Juan 
expedition survi ed it ; yet not one of the negroes who had 
accompanied them died on that duty ; and what renders the 
circumstance the more striking, is that the blacks were em- 
ployed in all the hardships and dangers of the enterprize. 
Dr. Lining has remarked that the negroes in Carolina were 
not subject to the yellow fever. The same thing was ob- 
served by Dr. Curtis in the island of Jamaica. Dr. War- 
ren, in his account of the yellow fever of Boston, in the 
summer of 1796, obser \ es that he did not know an instance 
of a black person being infected.* We are informed by 
Dr. Seaman that the yellow fever of New-York in 1795, was 
less fatal to the negroes than to the white inhabitants, and 
that none of the French emigrants from the West Indies 
were affected by it.-f " The African negroes," says "Lord 
Kaimes, "though li ing in the hottest known country, are 
yet stout and vigorous, and the most healthy people in the 
uni erse." 

We find that nature in the benevolence of her operations 
kindly adapts the constitution of man to the \ arious neces- 
sities of his situation. Thus, a climate which at first was 
sickly and pestilential toanatre of a cold and salubrious 
country, becomes at length, comparatively innoxious. — 
With the clime he also changes his complexion; and it has 
been uniformly found that the sable color of the African is 
the best possible protection against the otherwise scorching 
operation of a vertical sun. The skin of the negro is al- 
ways moist, and his perspiration free and unobstructed; 
and it seems to be owing to this great evaporation from 
their surfaces, that the jet black negroes of Sarnar, the hot- 
test country in the world, are two degrees cooler than the 
Europeans. Climate, in thus altering the color and com- 
plexion, adapts also, the constitution to the change of situ- 
ation. Beekman, in his voyage to and from Borneo, (Lon. 
1718) and other navigators assert that on the coast of Guin- 
ea, and in various parts of the torrid zone of Africa, many 
of their domestic animals, and particularly their dogs and 
common poultry, as well as the human race, are uniformly 
black. Whereas, towards the polar regions, white, as being 
a warmer colour, is the common livery of the animal world; 
and in many quadrupeds of these latitudes the colour is 
observed to change with the successive vicissitudes of sum- 
mer and winter. 



* Med. Repos. Vol. I. p. 135. 

f See a Collection of Papers on Bilious Fevers, by Noah Webster, p. 6 
nd 7; a book less known than its merit deserves. 



Bilious Remitting or Endemic Fever of 1821. &??' 

With regard to the greater exemption of Africans from 
the endemic fevers of hot and tropical climates, much is, 
no doubt, owing to the circumstance of their being natives 
of the country ; which, as already observed, whether in 
white or black, operates as a security against endemic dis- 
eases. We know, besides, that the negroes can endure the 
heat much better than white persons : and their colour is 
found by philosophical experiments to be the best possible 
protection against the excessive temperature of the torrid 
zone. Heat radiates more freely and readily from a black 
surface than from one of any other colour, and thereby af- 
fords in the negro a more effectual protection to the subja- 
cent integuments. It also appears that the perspiration o£ 
a negro is more free, and less liable to obstruction than that 
of a white man. 

The fever of which we are treating was particularly ma- 
lignant when it attacked habitual drunkards, or those who 
indulged in the excessive use of spirituous liquors. Many- 
had imbibed the notion from the votaries of the glass, that 
provided they kept themselves above fever heat, as they ex- 
pressed it, they would be secure against the prevailing dis- 
ease. How far this practice was successful I have not been 
able precisely to ascertain. I knew several who drank their 
pint of brandy or whiskey a day, and escaped the fever. — * 
This much, however, is certain, that when the disease at- 
tacked hard drinkers, the symptoms ran rapidly into the ty- 
phus state, from which no power in medicine could raise 
them. It was at one time adopted as a principle in medicine 
that no two general diseases can exist together in the same 
person. According to this doctrine, habitual intemperance 
might be considered as a disease, and during its continu- 
ance, might protect the body against the prevailing epidem- 
ic. Or, perhaps, to come nearer to the truth, we might say 
that intemperance fortified the body, or produced a degree 
of insensibility in it to other morbid poisons, in the same 
way as opium and other narcotics prevent the return of the 
fever and ague. But, in order to insure this effect the ha- 
bit of intemperance must be constant, regular and uniform. 
The experiment is hazardous ; and the wretched instances 
of the destructive effects of the intemperate use of spiritu- 
ous liquors, are demonstrated every summer in the southern 
towns and sea-ports of the United States ; where it is not 
very uncommon, to find in the morning, in some public 
place, one or more who have fallen victims to intoxication, 
and to the consequent exposure to the unwholesome damp* 
and vapours of the night. An instance of this kind occur" 
ac'2 



S?8 Bilious Remitting' or Endemic Fever 0/I82I. 

red in Cahawba in the summer of 1821, in a man to whom 
drunkenness was familiar ; with his handful of clothes he 
had left the town with the intention of proceeding to Port- 
land, a small village fifteen miles distant, but, unfortunately, 
he fell short in his calculation. He was found the next day 
at a spring in the vicinity of Cahawba, with his little bun- 
dle beside him, and free from any marks of external vio- 
lence. His bottle had become exhausted, and his lamp ex- 
pired. Flies and insects had taken possession of his life- 
less body. 

Dr. Drisdale, in his account of the yellow fever of Balti- 
more in 1 794, observes that all the first victims of this dis- 
ease, were persons habituated to the immoderate use of ar- 
dent spirits ; and asserts it as a melancholy truth, that very 
few of these unfortunate creatures could be rescued from 
death by all the powers of medicine. " In drinkers of ar- 
dent spirits," says he " the fever was excited not only with 
more facility, but was attended, also, with almost irresista- 
ble violence and malignity. " # It was remarked by Dr. 
Caldwell in the yellow fever of Philadelphia in 1805, that 
habitual drunkards, when attacked by this disease, were its 
most certain victims ; and that he did not recollect either 
to have seen or heard of a single recovery in a patient of this 
description-! 

There can be little doufct that a scarcity of good and 
wholesome vegitables had a considerable share in produc- 
ing a predisposition to this disease. It was seldom thata- 
ny article of culinary growth was brought to market or of- 
fered for sale. And it is to be regretted that a disregard 
to gardening and to the cultivation of wholesome vegitables 
is so generally prevalent. The settlers in this country 
should consider that they cannot here enjoy, during the 
summer months, the same salubrious air which they were 
accustomed to breathe on their native hills in Tennessee 
and Kentucky ; and what would there be safe and salutary 
is here dangerous and unwholesome. Upon the article of 
diet I have already dwelt at considerable length in the pre- 
ceding pages. I will here just repeat that the more entirely 
a person abstains from the use of animal food, during the 
sickly season, the greater will be his security from disease. 
There is a mutual co-operation between the influence of an- 
imal food and that of the noxious miasmata of decomposi- 
tion. They both have a tendency to vitiate the fluids of 

* Cox's Phila. Med. Mua. Vol. I. p. 30. 

f Essay on the Yellow ffiver. Appendix to <AJibert on the Malignant 
Intermit, p. 7SH 



Bilious Remitting Of Endemic Fever of 1821. 879 

the body, producing in them a morbid alkalescency, giving 
rise to the formation of an undue quantity of poisonous bile, 
deranging the healthy functions of the animal system, and 
acting reciprocally both as the predisposing and exciting 
causes of disease. 

By the careful regulation of the diet many cases of dis- 
ease would be checked in their formation : And if when 
persons feel the first symptoms of approaching fever they 
would restrict themselves to a sparing diet of vegitable 
food, with the use of some moderate cathartic, as rhubarb, 
castor-oil, salts, or two or three teaspoon fulls of cream of 
tartar, which with a few grains of rhubarb is one of the best 
purgati es in the Materia Medica, they would generally es- 
cape the threatened attack of disease. There are some, how- 
ever, who are such slaves to appetite, that to them all coun- 
sel and advice upon this subject would be useless and una- 
vailing. By them every privation is considered as an in= 
supportable hardship, "sufficient for the day is the evil there- 
of," is their adage ; u life let us cherish," their motto. — 
When such are the sentiments and practice of many, we 
need not be surprised at their suffering for their imprudence* 

During the early part of the season of 1821, fever and 
agues, and mild remittants had been common; and as they 
yielded without difficulty, and were attended with little 
danger, they excited no alarm or apprehension. The sum- 
mer continued tolerably healthy until towards the latter 
part of July, when the disease began to assume a character 
more obstinate and severe. In the month of August, the 
fever became still more malignant, putting on more of the 
continued form with a tense pulse. 

For the first two days of the disease, in many cases, there 
was little or no remission. In other cases a severe chill 
ushered in the complaint, with general pains in the head, 
back and limbs, and the fever went off after a continuance 
of from eight to twelve hours. Sometimes the invasion 
was marked only by a slight sensation of cold without any 
shivering — in others the fever arose without any percept- 
able chill whatever; though in the majority of cases a 
greater or less sensation of cold or chilliness was perceived 
at the invasion of the complaint; and I found it to be an 
invariable law of this disease, that the more severe the chill, 
the less dangerous was the disease. But when, as often 
happened, the fever came on without any sensation of cold- 
ness in any part of the body, I had reason to apprehend a dan- 
gerous and obstinate case. It was observed by Mr. Cleg- 
horn, that the most severe paroxysms of feyer which occur- 



$80 Bilious Remitting or Endemic lever of 1821. 

red in his practice, were those that commenced with a 
burning heat, without any previous cold fit.'^ The same 
thing was noticed by Dr. Gregory and by Sir John Pringle. 
This distinction in the character of the fever I ascertained 
at an early period of the epidemic, and it was among my 
first inquiries addressed to the patient, whether the parox- 
ism came on with, or without an ague or chill. Their 
views upon this subject were cfuite different from mine, un- 
til convinced of their error by personal experience/ 

There was in all a great accumulation of black, tarry, 
and dark green, bilious and very offensive matter, which 
was discharged in immense quantities by the exhibition of 
an emetic or cathartic ; and such was the disposition to this 
accumulation, that the frequent exhibition of purgatives be- 
came necessary to carry off the offending matter. The dis- 
charge of bilious and offensive colluvies, procured by the 
operation of a cathartic was immense, and sometimes con- 
tinued for the space of twelve hours, with but little abate- 
ment ; the stools still remaining black and ©ffensive to the 
last. 

In several instances the matter discharged from the bow- 
els, though of a black color, was free from any offensive 
odour. It was sometimes dark and grumous, and often of 
a flaky appearance, resembling a mixture of soot and water. 
In some a similar matter was discharged from the stomach 
by vomiting. After the second or third day the bowels 
were apt to become constipated. 

On some occasions a yellowness overspread the body, 
appearing first upon the face and breast ; and what was 
somewhat remarkable, this yellowness was, in some instan- 
ces, increased by the operation of a cathartic, and again di- 
minished when the bowels were at rest. It would seem 
from this that the purgative, though it dislodged the bile 
from the bowels, increased the activity of the lymphatics, 
and rendered the absorption of bile more abundant. 
f There was, during the exacerbation of the fever a tense 
and strong pulse ; and but little abatement of the tension 
took place during the remission. 

As to the remissions of the fever there was great variety; 
in the early part of the season remissions were apt to take 
place after the first twelve or twenty-four hours from the 
invasion of the fever ; and then the disease generally at- 
tacked with a chill more or less severe ; but subsequently, 
in many instances, the fever came on without any chill or 

* Diseases of Minorca 



Bilious Remitting or Endemic Fever of 1821. 381 

shivering, and often continued for twenty-four or forty- 
eight hours. In others a complete intermission took place 
on the second day ; and the patient flattered himself that 
the fever xuas broke, but the ensuing day convinced him of 
his error ; for the fever returned with increased violence. 
It was apt, however, to remit towards the close of the day ; 
though in this there was not much regularity ; for it often 
happened that the exacerbations did not take place till to- 
wards e ening, and sometimes they came on at night, tho' 
this was not common. 

It generally happened that the fever preserved more or 
less of the form of the double tertian, the patients being 
worse and better on alternate days ; a slight fever one day 
was succeeded by a more severe one on the ensuing, and 
vice versa. 

The return of the paroxysms took place, sometimes with, 
and at others without a chill ; though in the worst cases no 
coldness was perceptible ; but after an imperfect remission 
the fever again rose imperceptibly. Nor was there much 
regularity in the recurrence of the exacerbations. I have 
known the fever to rise and fall a dozen times in the course 
of the day; the pulse, at one time, being full, strong and 
tense, and the skin hot and dry ; and again, in a few min- 
utes, the perspiration would break out, the surface become 
cool, and the pulse, weak, soft and frequent. In some cases 
the fever would continue two or three days without any- 
thing like a remission. 

The urine was often high colored, and of a yellowish 
green, or deep saffron hue, being strongly*impregnated with 
bile. This was more especially the case when the skin was 
at the same time suffused with a yellow tinge ; upon stand- 
ing a little while it became of a dark red or brownish color, 
bearing a great resemblance to the strongest lie. 

One remarkable feature of the disease was proneness to 
prostration of strength. Sometimes this was the effect of 
evacuations procured by emetics or cathartics. At other 
times it took place early in the disease from the \ iolence of 
the causes which occasioned and supported the complaint. 
In both instances there seemed to be a deadly poison in the 
system which rapidly sunk and destroyed the powers of life. 
This prostration would sometimes come on suddenly after 
one or two operations of a dose of tartar emetic, esperially 
if it had acted upon the bowels so as to produce one or 
two copious evacuations by stool. In persons of robust 
constitutions who one hour before had a high fever with a 
strong and tense pulse, I have known this prostration to 



$82 Bilious Remitting or Endemic Fever of 1821. 

fake place to such a degree that the extremeties became as 
cold as marble and the pulse imperceptible. Where the 
prostration took place from the effects of medicine it was 
often recovered from, but when it came on spontaneously 
towards the termination of the paroxysm it was generally 
irremediable ; indicating the total exhaustion of the vital 
principle, or the mortification of some internal viscus, as 
the stomach or bowels. 

In many there was a remarkable variety of nervous af- 
fections, such as twitchings and tremulous motions of the 
muscles, rendering the limbs unsteady ; the tongue quiver- 
ed and trembled when protruded from the mouth ; the head, 
when the patient laid upon his back, moved from one side 
t® the other. These symptoms I remarked to be unfavor- 
able. During the exacerbation, the intellect was often de- 
ranged, and sometimes completely destroyed, the patient 
losing all consciousness, and lying in a state of stupor. — 
Sometimes a ray of understanding still glimmers on the 
mind, rendering the patient sensible to distress, which was 
expressed in low muttering, tossing of the arms and legs, 
and other agitations of the body. In some cases the pa- 
tient's derangement rose tb the wildest extravagance, caus- 
ing him to start with horror from the bed, making some 
fearful exclamation that he was assailed by savages and 
monsters ; and the strength of several persons became ne- 
cessary to confine him. 

In the advanced stage, typhoid or asthenic symptoms su- 
pervened ; and the patient was affected with an irresistable 
propensity to sleep. Upon falling into this lethargic slum- 
ber he was apt to be assailed by frightful dreams, and would 
suddenly start, perhaps with a scream in a state approach- 
ing to suffocation. The pulse was here frequent, and had 
lost much of its tension ; but the alvine discharges still con- 
tinued bilious and offensive. The tongue was dry, rough 
and chopped ; a clean or black streak often running through 
its middle,, and a white list extending along the margins. 

The skin in the hot stage was dry, hard, crisp, and con- 
stricted : the body, to the hand, feeling like a block of heat- 
ed wood. 

Upon the decline of the hot stage, the circulation at first 
grew languid in the extremeties, which often became cold ; 
though there might be at the same time, a violent pulsation 
-and throbbing of the heart, as might be perceived upon ap- 
plying the hand to the bosom, or even by the visible rjao- 
t:on of the thorax. 



Bilious Remitting or Endemic Fever of 1821. 383 

Early in the month of October, the symptoms again un- 
derwent a change. The tongue was clean and moist, even 
in the most severe cases ; though the tongues of persons in 
ordinary health were all more or less furred ; showing that 
all were impregnated with the morbid poison or matter of 
fever. Headache was common. The urine was small in 
quantity and high coloured, giving a red tinge to the linen 
wherever it touched, and was sometimes thick and viscid, 
appearing to consist principally of vitiated bile. This was 
remarkably the case in one patient, Mr. Morong, whose 
body was at the same time of a dark olive hue, from the 
suffusion of bile. He recovered. In other cases the urine 
was copious and limpid. The body, neck and breast, fre«* 
quently turned black soon after death ; when this was not 
the case, it generally turned to a deep yellow. 

The nervous system was much affected and deranged. — 
The patient's senses were stupified with profound coma, 
from which he could scarcely be roused for a moment — 
this was an unfavorable symptom. In the typhoid state 
delirious raving supervened. 

The patient was affected with strange feelings and fan- 
cies, sometimes imagining himself divided into two or three 
parts, that one part imposed upon the other, or did not bear 
an equal share of the suffering, &c; the mind was disturb- 
ed with frightful dreams and appalling apparitions, when- 
ever the patient fell into a slumber. 

In the case of a young gentleman, by the name of Brooks, 
to whom I was called in the advanced stage of the disease, 
and which case terminated fatally, I recorded the following 
assemblage of symptoms : — Tongue iirey red at the tip — 
white fur extending along the sides — papellas swollen and 
protruded — delirious raving — constant motion of the lips, 
the patient appearing to be talking to himself — perpetual 
restlessness, tossing of the arms and legs, rolling from one 
part of the bed to the other ; frequently changing his posi- 
tion from a horizontal to an erect posture ; desire to escape 
from confinement, and to throw himself out of the window 
—coldness of the extremeties and surface, though the pulse 
possessed considerable strength, and was notmuch increased 
in frequency- — complained of great heat, whilst the body to 
the touch was colder than natural— unwilling to be covered 
in bed — extreme restlessness and anxiety. When asked 
how he felt, he was excited to momentary attention, and 
replied, " I feel like a crazy man." He discharged before 
his death, some large round worms by vomiting and stool, 
together with dark coloured matter. From the coldness of 



-3S4 Bilious Remitting or Endemic Fever ofl&2i. 

the body he was put into the warm bath, by which he was 
somewhat composed, whilst for a few minutes he remained 
in it ; but no kindly perspiration and gentle warmth suc- 
ceeded — -his body, in a short time, after being taken out of 
the bath, became intensely hot, and the pulse frequent and fee- 
hie. I pronounced him past all hopes of recovery when I was 
first called to him, and I was not mistaken in my prognosis. 

The yellowness frequently appeared upon the body at an 
early period of the disease, viz : the second or third day. 
The appearance was often sudden and universal at the same 
time. 

The appearance of long round Worms, which were often 
discharged from the stomach and bowels, did not in itself 
afford any prognosis ; though as far as my observation ex- 
tended, it was confined to the more severe cases of the dis- 
ofder, and took place chiefly in children and young people. 

The eye exhibited > arious appearances. It was dim, lu- 
rid and suffused with tears, or glassy, vacant and inanimate; 
sometimes red and blood-shot, with an intolerence of light; 
at others, sunk and insensible to surrounding objects. 

In some, eruptions appeared upon the surface of the bo- 
dy, more especially upon the face, in the form of watery blis- 
ters, which, upon breaking, formed into blackish scaly in- 
crustations. They commonly first made their appearance 
about the mouth and nose, and in a short time become gen- 
eral. These eruptions indicated, as old authors would say, 
a rapid tendency to putrefaction ; as in persons affected in 
this way, signs of mortification appeared immediately after 
death. 

Haemorrhages from the nose were common, and some- 
times blood was discharged from the stomach and bowels. 
In one or two cases I observed grumous blood mixed with 
the urine. 

The matter discharged from the stomach, either from the 
exhibition of an emetic or spontaneously, was of various ap- 
pearances ; the most usual, after the fluids recently taken 
in had been discharged, was a deep yellow viscid bile. In 
many instances vast quantities of this were discharged by 
the operation of a single emetic ; in others, the matter re- 
jected from the stomach was of a grass green color, but 
much less in quantity than the preceding, and not uniform- 
ly blended, but of a flaky * iscid appearance, with a mixture 
of slime or mucus. In some this matter appeared of a dark 
brown, in others approaching to black. 

The black discharges which took place from the bowels, 
as already described, I took to be the same as what is ca-1- 



Bilious .Remitting or Endemic Tever of 1821. 88S 

led the black vomit, though it was discharged in immense 
quantities. Generally it was not perfectly black, and stain- 
ed the linen of a dark green colour. When it was entirely 
black, it was for the most part free from foetor, and entirely 
inodorous. The generation and reproduction of this mat- 
ter was astonishingly great and rapid. I do not think that 
I shall be guilty of any exaggeration, when I say that I have 
known from a gallon to two gallons of this black matter to 
be discharged daily from the bowels, for four or five days 
successively : so strongly was every part of the human 
frame infected with the pabulum of disease, that there seem- 
ed to be a disposition in the system to convert the whole ani- 
mal substance, both solids and fluids, to this same black, 
carbonacious and vitiated colluvies. These discharges were 
commonly more offensive at the commencement of the dis- 
ease, and became less so during its progress. Sometimes 
the alvine evacuations were small in quantity, free from foe- 
ter, and of a flaky and ash-coloured appearance. 

The disposition to drink was various ; though commonly 
there was a great inclination for cold water. Acids of all 
kinds were generally very grateful. In many cases there 
was an excessive thirst, attended with great irritability of 
the stomach, which occasioned the fluids to be rejected as 
often as they were received. In such cases I was sometimes 
obliged to prohibit drinks of every kind, except in very 
small quantity, for several hours. 

The blood drawn in this disease was generally dense, 
black and cohesive, and free from that attenuated and dis- 
solved condition which authors describe as characteristic of 
putridity in malignant diseases. Not unfrequently the cras- 
samentum was covered with the buffy coat, as in cases of 
local inflammation. 

Throughout the summer there were scattering cases of 
intermitting fever, which yielded to the ordinary remedies 
in that complaint ; though in some instances where this 
mild appeal ance of the disease was neglected, I have known 
it suddenly assume the symptoms of the bilious remittent 
in its most aggravated form. It was this tendency to as- 
sume the character of the prevailing epidemic that rendered 
every indisposition a cause of fear and apprehension : and 
many cases which appeared slight, and scarcely worthy of 
notice at their commencement, by neglect soon become dan- 
gerous and alarming. 

Sweats were more common at the close of the first and 
second exacerbations than at subsequent periods. After 
the first or second day it was not uncommon for the skin t# 
r 2 



886 Bilious Remitting' or Endemic Fever of 1821. 

become dry and constricted, and perfectly impervious t» 
moisture. 

The temperature of the surface of the body was various, 
independent of any thing connected with the remission of 
the fev er. Not unfrequently it was below the natural stan- 
dard, more especially in the advanced stage of the disease, 
or where the vital energy appeared to be suppressed and 
subdued by the violence of the causes which supported the 
disease. In others the heat was violent and intense ; and 
in a few cases I discovered that burning caustic sensation 
to the touch, which authors describe as characteristic of ma- 
lignant fevers. This sensation was more perceptible im- 
mediately before the sweat broke out upon the surface. 

A burning heat and distressing sensation at the pit of the 
stomach were not uncommon ; sometimes these amounted 
merely to a slight uneasiness, or a sense of weight and op- 
pression ; at others it arose to a great difficulty of breath- 
ing and suffocating sensation. 

At the invasion of the paroxysm some Were seized with 
violent pains in the stomach and bowels, together with se- 
vere and excessive vomiting. It was frequently in vain to 
attempt to restrain this affection by the exhibition of medi- 
cine by the mouth ; for the mildest as well as the most a- 
greeable and cordial drinks were alike rejected, being often 
expelled with such violence as to be thrown across the room, 
provided the patient Was in an erect position. 

The vomiting, however, was not confined to any particu- 
lar period of the complaint, but in such persons as were sub- 
ject to it, who indeed were many, it continued to recur at 
intervals throughout the progress of the disease. 

Dysenteric symptoms were not uncommon. When these 
took place, the fever, in a great measure, or entirely disap- 
peared, and again returned upon the cessation of the dysen- 
teric affection. This form of the disease was not peculiar- 
ly dangerous, but generally 3 T ielded with facility to proper 
treatment. 

The sanguiferous system was variously affected in this 
disease. In the early part of the season, during the exa- 
cerbation the action of the arteries was increased in force 
and frequency, though there was little or no tension per- 
ceptible to the touch. Towards the latter part of August 
•and throughout the remainder of the sickly season, which 
continued till the 20th of October, the symptoms became 
more inflammatory, with a frequent, strong and tense pulse; 
such, at last, was the state of the arterial system at the com- 
mencement, but it frequently happened, upon the subsid- 



Bl lions" Remitting or Endemic* Feu-er of 1821. 38 7 

ence of the first exacerbation that the arterial action became 
weak, thread like, frequent and almost imperceptible. This 
debility of the blood vessels was of various duration ; some- 
times the pulse rose on the second or third day, in others 
this state continued for seven or eight days, when the arte- 
rial action again developed itself in strength and fulness. 
In one patient, Mr. LaTourette, who fell a sacrifice to this 
disease, the vascular system never acquired any strength 
and fullness after the first twelve hours ; but throughout 
the disease there was a great prostration of the vital action; 
whilst at the same time the strength of the muscular system 
was disproportionab-y great. This young gentleman was 
affected with inexpressible anxiety and restlessness. Re- 
monstrances and intreaties were alike ineffectual in confin- 
ing him to the same situation. He would occupy succes- 
sively, and in a short time every bed in the chamber, and 
such was his muscular strength, that, without any apparent 
difficulty, he would walk from one part of the room to the 
other, though, at the same time his pulse was scarcely per- 
ceptible. He was constantly complaining of a distressing 
sensation of heat, and insisted upon being exposed naked 
to the open air, whilst his skin, to the.touch was below its 
natural temperature. His bowels, after the first twenty- 
four hours, became constipated, and no medicine though 
aided by injections could be brought to act upon them ; 
nothing was discharged but a little inoderous, clay, or ash 
colored flaky matter. Till within about twenty-four hours 
of his dissolution his intellect remained free from derange- 
ment. It was painful and distressing to behold the closing 
scene of this amiable young man ; with an agonized body 
and distracted mind he was constantly giving expression to 
his delerious wanderings. Since the commencement of his 
fatal indisposition sleep had not closed his eye-lids, nor had 
slumber soothed into soft oblivion his disordered senses ; 
and when in the stillness of the night he would endeavor to 
compose himself to rest, strange phantoms and terrific appa- 
ritions of uncreated horrors immediately arose in dread ar- 
ray to his imagination : waking was wretchedness, but these 
fitful visitations of distempered slumber were dreadful in 
the extreme. " His mind, like his body, lay in ruins, in 
scattered fragments of disordered thought." These imag- 
inary terrors were not peculiar to himself alone, many com- 
plained of the same dreadful and distressing phantoms. 

A disregard to modesty, in the exposure of the body, 
was an unfavorable symptom. The same thing was obser- 
ved by Dr. Rush in the bilious yellow fever of Philadelphia 
.in lT98 r and by Boccacio m thejplague in Italy. 



l^SS Bilious Remitting or Endemic Fever ofl82t* 

An impatient desire to ride into the country was a fatal 
symptom, where it occurred in severe cases. 

The inequality in the distribution of strength, between 
the arterial and vascular systems, constituted a striking fea- 
ture of this disease. Sometimes, though much more sel- 
dom, the reverse of this took place ; the pulse indicating 
considerable strength of vascular action, whilst the debility 
of the muscular and nervous systems was so great, that the 
patients were unable to continue, even for a few moments, 
in an erect position in the bed. Even the exertion of re- 
maining for a few minutes at the close stool has produced 
an alarming state of syncope. The variation of muscular 
strength was observed in the yellow or bilious fever of 
New- York in 1795, by Dr. E. H. Smith.* 

There was one circumstance worthy of particular notice 
in treating of the affections of the vascular system, and that 
was the vio'ent palpitation of the heart, v/hich was observa- 
ble in cases of high excitement. This was generally accom- 
panied with an intense heat of the surface, great pulsation 
of the carotids and throbbing of the temples. Notwith- 
standing this palpitation and irregular action of the heart, 
the pulsi at the wrist, though frequent and tense, was at the 
san .• ilme perfectly regular : to this, howe er, there were 
some exceptions, more especially in the advanced stage of 
the complaint, when with the continuance of this palpitation 
the pulse became weak and intermitting. 

In a few cases the pulse was slower than natural, at the 
same time intermitting every second, third, fourth or fifth 
pulsation. 

Towards the decline of the first or second exacerbation 
the pulse often became extremely frequent, and sometimes 
irregular and intermitting. Great prostration was apt to 
supervene, and there seemed to be an alarming indication of 
danger : in a few hours, how ever, the pulse would become 
softer and less frequent. 

The pulse was not always a sure indication either of dan- 
ger or of safety; nor could any accurate conclusion be drawn 
from it, unless taken in connexion with the other symp- 
toms. Thus, I have known a pulse small, thead-like, scarce- 
ly perceptible, and going at the rapidity of 130 pulsations 
in a minute, in a patient whose symptoms were not other- 
wise alarming, and who recovered in the ordinary time. A- 
gain, I have known a pulse full, tolerably strong, and net 
much increased in frequency, in patients within twenty min» 

J See Webster's CQllectiQn ©f papers on bilious fever? , 

i 



Bilious Remitting or Endemic Fever of 1S21. 389 

utes of their death. It is not so much from the condition 
of the pulse as from the state and affection of the nervous 
system that the prognosis in this disease could be accu- 
rately formed. The age, habit and constitution of the pa- 
tient had also considerable influence in varying the state of 
vascular action, and aiding in the formation of an accurate 
prognosis. In persons of delicate habits, especially females, 
the circulation is naturally weak, small and frequent : and 
symptoms that in a person of a robust constitution, would 
lead us to form a fatal prognosis, in one of a delicate and 
debilitated habit would, perhaps, be free from danger. 

There was, in many cases a great determination of blood 
to the head. This was indicated by head-ache, violent pul- 
sation and throbbing in the temporal arteries, hamorrhagies 
from the nose, stupor, aberations of intellect and violent de- 
lerium. It was this affection of the brain more especially 
that constituted a great part of the danger in this disease : 
Provided the head was tolerably free from pain, the patient 
composed and the intellect clear, the countenance calm, and 
free from anxiety and dejection, the patient might generally 
be considered free from danger, though at the same time 
there might be a degree of tension with increased frequen- 
cy of pulse. 

Hamorrhagies from the nose generally took place in the 
early stage of the disease, and were evidently owing to a 
great determination, and consequent accumulation of blood 
in the vessels of the head. Sometimes blood was dischar- 
ged from the stomach by vomiting, and bloody stools were 
still more frequently observed. In some the flow of blood 
from the nose was very copious and obstinate ; but its ef- 
fects were generally salutary, though it marked an aggrava- 
ted form of the disease. 

The spleen, liver, lungs, stomach, bowels, brain and oth- 
er viscera were often the seats of local congestion and a de- 
gree of inflammation. The li- er and spleen were subject 
to considerable enlargement from accumulation and con- 
gestion of blood. The stomach, also, in many cases was 
affected with more or less inflammation ; patients often 
complaining of a burning heat, pain and oppression at the 
epigastrium, being at the same time affected with sickness 
and vomiting. In like manner the bowels were more or 
less affected, as indicated by pain, tormina and flatulency. 
Patients often objected to taking nourishment and medi- 
cine, from their producing an uneasy sense of distention : 
According to their account, the substances taken had lodged 
in the upper part of the stomach, and were incapable of pro-* 



#90 Bilious Remitting or Endemic Fever of 1821. 

ceeding any further : A sense of choaking and fulness of 
the throat prevented their receiving any thing by the mouth, 
except in very small quantity at a time. 

The pain and misery in the stomach and bowels was some- 
times so violent and severe as to extort cries and exclama- 
tions of distress. Great anxiety pervaded the body, and 
the patient, writhing under the severity of his sufferings, was 
incessantly changing his position. The small of the back 
was. often, likewise, the seat of severe pain, more especially 
during the height of the paroxysm. 

Great constriction and constipation of the bowels often 
took place in this disease. The most drastic purges could 
sometimes only affect a very partial operation ; a small dis- 
charge of flaky ash-colored fceces was often all that could 
be procured by the exhibition of a cathartic. The relief in 
such cases was but slight and imperfect, and repeated ca- 
thartics and enemata, became necessary to keep up anything 
like the natural peristaltic motion of the bowels. This state, 
however, generally yielded sooner or later to the exhibition 
of purgative medicines and the repeated use of injections. 

The lungs were often more or less affected. Nor was this 
complaint entirely confined to the cool weather of autumn. 
A slight cough with pain in the side was common. In some 
cases these symptoms were almost as acute as in cases of 
idiopathic pleurisy ; and the same treatment became neces- 
sary for their removal. In one patient I found it necessary 
to extract 76 ounces of blood in the course of a day and 
night, before this pain was entirely relieved, or the pulse 
considerably softened. In some cases these pains appear- 
ed to proceed from affections of the liver and spleen, which 
were liable to inflammation and enlargment. The pains, in 
such instances, were not confined to the seat of the inflam- 
mation, but extended into the shoulders, the arms, wrists 
and hands, affecting the deep seated parts, as also the lum- 
bar region on one or both sides of the spine. An abscess 
formed in the lungs of one patient; and a short time previous 
to his death he threw up by coughing nearly half a pint of 
purulent matter. Sometimes the affections of the lungs ob- 
served periodical recurrences, abating, or disappearing en- 
tirely with the remission, and again returning upon the ex- 
acerbation of the fever. Mucus r.nd not unfrequently blood 
were expectorated by the efforts of coughing. 

There was often a collection of viscid phlegm in the throat 
and bronchise, which was expectorated or removed with dif- 
ficulty, and became the source of great uneasiness to the pa- 
tient _; and sometimes death seemed to be occasioned by the 



feiiioas Remitting or Endemic Fever of 1821. 391 

sudden effusion of phlegm and lymph into the air-cells of 
the lungs, thereby producing suffocation. This was more 
especially the case with children, many of whom were af- 
fected with the characteristic symptoms of the cynanche 
trachealis, or croup. I saw one patient to whom I was cal- 
led late in this disease, in whom there appeared to have been 
formed an abscess in the stomach. This patient, two days 
previous to his death, threw up by vomiting, a considerable 
quantity of pus and the corrupted matter of supuration. 

It has already been remarked that the brain was often af- 
fected in this disease : which appeared from the flushing of 
the face ; heat of the forehead ; pain in the head ; hermor* 
rhagies from the nose ; coma ; delerium ; redness of the 
eyes, squinting ; dilatation of the pupils ; in some instances 
insensibilty to light, and in others an intolerance of light and 
noise. Sometimes the intellect was entirely destroyed, the 
patient being perfectly unconscious of every thing : in oth- 
ers a feeble glimering of intelligence remained ; by loud 
speaking the patient could be roused to some degree of at- 
tention ; he would open his eyes and perhaps answer in 
monosyllables to the questions addressed to him ; but the 
spark was soon again extinguished in total darkness. Drinks, 
medicine, or nourishment might be forced into the patient's 
mouth in this situation, but as soon he became in any de- 
gree conscious of its presence it was instantly spit out. 
When an acquaintance, upon entering the room addressed 
him, he would perhaps, be roused to a momentary recollec- 
tion, and express a satisfaction in seeing his friend. Mr. 
Joseph Bogle, a worthy and lamented young man, when 
roused from his lethargic slumber, by the address and in- 
quiries of an acquaintance, replied, " I am very happy to 
see you, the presence of a friend is always agreeable, but 
particularly so in the time of sickness :" his understanding, 
however, glimmered only for a moment ; it became exhaus- 
ted by the slight exertion, and sunk into its former state of 
utter inactivity and apparent annihilation. When inquired 
of, how he felt, he would say, " quite well ;" and again he 
would fall into his former state of profound stupor : it was 
the sleep of impending death. * Such cases, however, were 
but comparatively few : nor did all who were carried off" 
with this disease, depart with this affection of the brain and 
nervous system ; though few expired with a clear uncloud- 
ed intellect. I knew of but two that died in possession of 
their understanding ; one at the termination of the parox- 

* Sopor profundus et altus omnjno damnanclus est. Hippoc. Gasrc, 
P*$nj& Opera, CUn. p. 1W, 



392 Bilious Remitting 1 or Endemic Fever ojiBZi, 

ysm, and the other from the exhaustion and debility of pro- 
tracted illness : the former was Miss Caroline Campbell, 
the patient of a friend. I witnessed the closing scene of this 
amiable young lad) . In the morning she was free from fe- 
ver, and conversed cheerfully with her female friends and 
sisters; about noon she was taken with a slight chill, which 
was succeeded by a fever, upon the subsidence of which she 
died, about 9 o'clock p.m. As the fever went oif her strength 
became suddenly and alarmingly prostrated. When I saw 
her, her hands and feet were cold, and her pulse feeble, faul- 
tering and scarcely perceptible. As life withdrew from the 
-extremities, and retreated towards the heart, she became af- 
fected with extreme anxiety and distress. She was pre- 
vailed upon t:> take, from time to time, some wine sangre, 
yet she was too conscious of her situation to belie' e that it 
could be of any service. A short conflict between life and 
death put an end to her earthly sufferings. 

Though death might take place without any material af- 
fection of the brain, yet when there was much derangement 
of the nervous system there was great danger to be appre- 
hended. This state I have reason to believe arose in most 
instances from too great a determination of blood to the 
head, and from congestion in, and a degree of inflammation 
in the brain itself. This I infer from the symptoms whLh 
have been enumerated, as well as from the circumstance of 
Its taking place only or chiefly in those cases where high 
arterial excitement had previously existed. 

It is possible that the state of the weather may have had 
considerable influence in giving a particular cast and char- 
acter to the fever. The influence of dry weather and dry 
situations in giving an unusual determination of blood to 
the head has been noticed by Dr. Hillary and Dr. Jackson 
In the fevers of the West-Indies ; the same thing was re- 
marked by Dr. Rush in the bilious remitting fever which 
prevailed in Philadelphia in the year 1793. As the sum- 
mer of 1821, in Alabama, was not remarkable for drvness, 
but rather the contrary, the above consideration will not 
enable us to account for the affection of the brain ; and we 
are therefore induced to attribute this symptom, or combin- 
ation of symptoms to the general causes of the epidemic. 
This affection of the brain is also taken notice of bv Dr. E. 
H. Smith, in his account of the yellow, or bilious fever of 
New- York in 1795, though the season was remarkably wet.* 

* " The marks of -congestion in the brain," says Dr. Smith, " were too 
Unequivocal to be mistaken. A violent pain in the head was one of the 



Bilious Remitting or Endemic Fever of 1821. SP 

l?rom the frequency of affections of the brain in febrile 
disorders, Dr. Clutterbuck was led to consider inflamma- 
tion of this organ as the proximate cause of fever. It re- 
quires, however, but a very slight observation to show the 
falacy of this opinion ; and Dr. Clutterbuck, by careful ex- 
amination, might have found, that other viscera of the body 
are as frequently inflamed in fever as the brain itself. It 
often happens that these inflammations supervene and exist, 
yet in a degree so much below acute and idiopathic inflam- 
mation, as scarcely to be productive of pain or uneasiness; 
and it is only from examinations after death and from the 
consequences of fever that we are assured of the fact. Thus, 
an incipient inflammation of the liver, commenced during 
the presence of the fever, but which, perhaps, excited no 
attention at the time, continues after an incomplete recove- 
ry from the febrile symptoms, and goes on increasingYill it 
sometimes ends in suppuration. 

Suppression of urine sometimes occurred ; and, generally 
speaking, unless this secretion was promoted by the use of 
diuretics it was small in quantity, thick and high colored, 
and sometimes turbid. I have known the suppression in 
fatal cases to continue nearly two days, without|being ac- 
companied by any pain. Though a copious secretion of 
urine or a kindly perspiration was a favorable symptom, it 
often happened, that the paroxysms subsided, and convales- 
cence was finally established without any marked crisis of 
either of these secretions : yet in such cases the bowels be- 
came free and soluble, easily operated on by laxatives, and 
the morbid matter seemed to be evacuated by stool. 

Sweats were common at the subsidence of the first or se- 
cond paroxysm ; after this, in violent cases, the skin be- 
came dry and constricted. Nor were sweats of any ser- 
vice when forcibly excited by stimulating means during the 
continuance of the fever. This circumstance is worthy of 
consideration; and I am clearly of opinion that much injury 
was done in the disease by the injudicious use of hot snake 
root tea, in cases of considerable excitement of the blood 
vessels, with the view of producing sweat. On several oc- 
casions I found it necessary to moderate and suppress this 
excretion, as much as possible, on account of its debilitating 
effects. I have known it, for hours, to pour like rain drops 

earliest, most constant, and most distressing 1 sj'mptoms of this diseases 
Coma Was a very frequent symptom ; and, as I thought, in proportion to 
the severity of the disorder. Towards the close it amounted almost to 
fotai stupefaction ; it being- scarcely possible to rouse the patient." 
Webster's Collection of Papers on Jiiliofts F^ver?, p. U? \ 



394 Bilious Remitting or Endemic Fever of 182i, 

from the patient's body. When thus excessive, so far from 
being serviceable, it was, more especially, in the ad anced 
stage of the disease, a dangerous and alarming symptom, 
as indicating a degree of atony and relaxation of the exhal- 
ents, the very reverse of healthful or salutary perspiration. 
These sweats were often accompanied with a coldness of 
the surface and extremities ; and when occuring late in the 
complaint might be considered as affording an unfavora- 
ble prognosis. They sometimes appeared at an earlier pe- 
riod, during the subsidence of the paroxysm, more especial- 
ly if active medicines, such as emetics or cathartics, had 
been employed in the exacerbation. Cases of this descrip- 
tion were not dangerous; and provided stimulating remedies 
were employed in time, and duly persisted in, the patients 
generally recovered. I have known such sweats to contin- 
ue for hours, with a coldness of the surface and extreme- 
ties, and without any pulsation of the artery at the wrist, and 
yet the patient recovered : Such recoveries, however, only 
took place where the prostration occurred in the early stage 
of the disease. Sometimes the skin, from being dry and 
parched, became suddenly covered with a copious exunda- 
tion of sweat, wetting, like rain, the bed clothes and body 
Jihen of the patient. If together with these sweats there 
was coma or derangement of intellect, great danger was to 
be apprehended. 

The appearance of the tongue in this disease was various 
in different patients during the same part of the season, and 
a difference was also observable in different periods of the 
epidemic. At the commencement of this complaint, the 
tongue was moist, and generally more or less covered with 
a white fur. From white or yellowish it became dark to- 
wards the close of the complaint, whether the disease ter- 
minated in death or convalescence. It was not unusual for 
the tongue, which for the first four or five days had been 
covered with a glutinous pellicle, to become quite clean at 
a later period, and continue so till the termination of the 
disorder. Sometimes this furry substance would reappear 
in different stages of the disease. In some patients the 
tongue was red, clean, smooth, dry crisp & of glassy smooth- 
ness, the papillae being entirely effaced. When the whole 
surface of the tongue exhibited this appearance the progno- 
sis was unfavorable ; when the tip of the tongue only was 
in this state, and free from that fiery or crimson redness be- 
fore stated, whilst at the same time the rest of the tongue 
was moist and clean, or slightly covered with a white fur, 
less danger was to be apprehended, In fatal cases the tongue 



Bilious Remitting or Endemic Fever of 1821. 895 

ivould sometimes become rough, dry, black, horny and fur- 
rowed with deep fissures ; in others it would continue moist 
and clean, and sometimes black ; or if during the preceding 
stage of the complaint it had been dry, it wculd become 
moist previous to death. Sometimes it was moist and of a 
crimson redness, the papillae much enlarged, and the poste- 
rior part of the tongue covered with a greenish or yellowish 
fur. In some cases the tongue was whiteish and sodden, 
as if parboiled, the fur being very short, gi\ing to the sur- 
face beneath a bluish cadt. In the latter part of the season 
when the symptoms became more inflammatory, the tongue 
was generally cleaner than it had been at the commence- 
ment of the epidemic : and it was not unusual for very in- 
flammatory symptoms to prevail, and such as required the 
repeated use of the lancet, though at the same time the 
tongue presented an appearance perfectly healthy. Nor 
could any correct opinion be formed as to the propriety or 
impropriety of exhibiting emetics, from the cleanness or 
foulness of the tongue. In some, the tongue presented a 
whitish appearance, and trembled when protrudud from the 
mouth. In others it was smooth, red and shining. A 
tongue free from fur, but at the same time covered with a 
slimy mucus was unfavorable, as indicating a strong ten- 
dency to asthenia. A tongue clean and of a hea ! thy ap- 
pearance, when the other symptoms were unfavorable, af- 
forded a dangerous prognosis. In the advanced stage of the 
complaint the patients sometimes complained of numbness 
of the arms, legs or thighs. 

Dropsical swellings of the extremeties were a common 
consequence offerer. In some cases these threatened the 
invasion of a general dropsy; not being confined solely to 
the feet and legs, but extending over the whole surface of 
the body, the abdomen at the same time being considerably 
tumid. Sometimes this dropsical effusion was coincident 
with the febrile affection, appearing evidently to depend upon 
an increased action of the sanguiferous system; the swelling 
increasing with every exacerbation, and again diminishing 
with the remission of the fever. That those swellings were 
in some degree connected with a relaxed and debilitated 
state of the exhalent arteries appears reasonable ; yet there 
were many cases of extreme debility where these dropsical 
effusions never made their appearance : and in general, 
though not always, they were more liable to happen during 
the state of convalescence, than towards the decline, or soon 
after the cessation of the fever. Perhaps the circumstance 
may be accounted for in this way, that the larger .arteries 



396 Bilious Remitting or 'Endemic Fever ofi821, 

recovering their healthy tone and energy sooner than the 
anastomosing branches and exhalents, acted with a degree 
of strength and vigor disproportionate to the exhausted 
condition of the minute vessels. However this may be, 
these affections were not generally serious in their conse- 
quences ; but yielded without much difficulty to the appro- 
priate remedies. 

Several persons lost a considerable portion of the hair of 
their heads, as the consequence of fever. 

Neither age nor sex afforded an exemption from this dis- 
ease. To women in a state of pregnancy it proved unusu- 
ally malignant, few surviving that were affected by it. In 
them the inflammatory, and what the older physicians would 
call the symptoms of putridity, ran higher, and the fever 
assumed a more continued unremitting and protiform char- 
acter. Though I saw several I had myself but one patient 
of the discription ; the case for a few days appeared dan- 
gerous and doubtful ; the disease, however, went through 
its course in the usual time, and ended in recovery. 

Children were also very liable to attacks of the disorder; 
but in them, though the symptoms often ran high, yet, in 
general, the fever was less obstinate than in adults, yielding 
with facility to the remedies employed ; and often disap- 
pearing entirely upon the exhibition of an emetic and cath- 
artic. In children the fever was marked by some peculiar- 
ity : they were generally comatose duVing the continuance 
of the febrile excitement ; and not unfrequently the intel- 
lect, for a time, was entirely destroyed ; yet upon the subsi- 
dence of the fever this affection of the sensorium commune 
disappeared ; the mind again became lucid and composed, 
and frequently the little patients at the end of the parox- 
ysm would rise from the bed, and pursue with cheerfulness 
their accustomed amusements. In them also the appetite 
was less impaired ; and I have often seen them eating with 
avidity, previous to any considerable abatement of the fever. 
They were likewise more free from pains, anxiety and dis- 
tress than patients of mature years ; the causes which pro- 
duced great uneasiness and commotion in the latter, appear- 
ing to operate with such force upon the more delicate nerves 
of children as to destroy all consciousness and perception 
of existing irritation. 

The disease was more unfavorable in fat and corpulent 
persons. We know that fat people, even in health, are 
more easily evercome with heat and exercise than those of 
a thin spare habit. This seems to be owing to two causes; 
&rst, the adipose covering that invests .the body is a bad 



bilious Remitting' or Endemic Fever of 1821. 397 

conductor of heat ; hence the excess of temperature gener- 
ated by exercise and the increased activity of the circula- 
tion is not transmitted with facility to the surface, and car- 
ried off by perspiration. It appears to be owing to the cir- 
cumstance of fat and oil being bad conductors of heat, that 
warm blooded animals, inhabiting the ocean, as the whale, 
porpoise, &c. aTe enabled to maintain their temperature, e- 
ven under the intense cold of the polar regions. Second, 
in man this undue accumulation of adipose mattei in the 
celular texture straitens and impedes the freedom of the cir- 
culation; in consequence of which the blood is, in a measure, 
excluded from the surface and accumulated in undue quan- 
tity in the interior cavities and viscera of the body ; and 
the lungs, from being gorged with blood, are forced to more 
frequent and laborious respiration in order to facilitate its 
passage. Hence fat persons are often subject to apoplexy. 
In fever we frequently find the pulse of corpulent persons 
extremely small and feeble ; often faultering, and liable to 
sink upon an aggravation of the febrile cause. 

I observed, in several instances, a difficulty in swallowing, 
not only in cases that terminated fatally, but likewise in 
these which were finally recovered from. I had previous- 
ly observed this affection in Florida to denote great danger, 
though the other symptoms at the time might not seem im- 
mediately alarming. In the disease under consideration, 
however, it by no means attended every case that termin- 
ated unfavorably ; and it was not uncommon for the pa- 
tient to swallow with facility whatever was offered him till 
within a few minutes of his death. 

Hiccup was a symptom of frequent occurrence. When 
it came on at a late period of the disease it indicated dan- 
ger. I have known it to occur at an earlier stage, and to 
be very distressing ; returning at intervals, upon swallow- 
ing any thing which produced an irritation in the stomach. 
It occurred only, or chiefly in cases of great weakness and 
irritability of the stomach, in consequence of prostration, 
and protracted illness ; and when supervening in the ad- 
vanced stage of the disease, there was reason to apprehend 
an incipient mortification of the stomach and bowels, or a 
-degree of atony and relaxation incompatible with recovery. 

In some cases the surface of the body acquired a morbid 
degree of sensibility ; the patients complaining of a sense 
of soreness when touched or handled without the utmost 
care and tenderness. Others complained of a numbness of 
the extremeties, or of some part of the body, commonly 
ponfined to one leg, side, or arm, 



•398 Bilious Remitting or Endemic Fever of 1821. 

Many persons were affected with large blotches or whelks 
on different parts of the body, often without any other symp- 
tom of indisposition. These blotches appeared like the ris- 
ings on the skin produced by the bites of musquetoes, but 
much larger, and very irregularly circumscribed. They 
seemed to depend upon the same vitiated state of the fluids 
that produced the fever itself, and where they appeared 
without any other symptom of disease, were removed by 
the operation of a cathartic. Sometimes they appeared as 
a symptom of fever. Cases of this kind are to be met with 
every summer, both as an idiopathic complaint, sometimes 
attended or preceded by some degree of sickness and fever, 
and at others as symptomatic of the common endemic of the 
country. Such blotches or eruptions were observed by Dr. 
E. H. Smith in the yellow or bilious fever of New-York in 
1795. 

The memory was sometimes impaired in this disorder ; 
and such was the imperfection in the exercise of the intel- 
lectual faculties, that patients upon recovering from the fe- 
ver reflected upon the incidents of their illness as upon the 
fantastical illusions of the night ; the whole of what had 
passed appearing like a dream imperfectly remembered. 

A symptom which I remarked in several 6f the worst ca- 
ses, though mostly in such as terminated in recovery, was 
the strange fancy of the patient's imagining himself to con- 
sist of, or to be divided into, two or three distinct persons, 
placed side by side, in the same bed, and that one person 
was obliged to endure all the distress, and receive all the 
medicine, whilst the others lay at their ease, and indulged 
freely in the luxury of drinking cold water. It was at the 
same time a subject of pity rather than amusement, to hear 
the half deranged and dreaming patient, after taking a dose 
of medicine, to direct a portion to be given to the other side. 

As may reasonably be supposed, there was but little or 
no appetite for nourishment in this disease, and gruel, though 
recommended and taken to support the strength, and to as- 
sist the operation of cathartics, was often unsavory and dis- 
gusting. Upon the abatement of the fever solid food was 
more grateful than fluid. One patient who had not tasted 
any nourishment for several days, desired, as the first crav- 
ings of returning appetite, a piece of broiled ham and salt 
nsh. He followed, in this particular, his own council and 
the dictates of his feelings. The salt fish and ham agreed 
with him, he rose from his bed dressed himself and walked 
to his store ; upon returning he again had recourse to this 
agreeable refreshment, and found himself much better,- 



Bilious Remitting or Endemic Fever of\%%\. 399 

From fish and bam his appetite soon acquired its accustom- 
ed relish of a more suitable and delicate variety. 

During the summer there were but few who did not suf- 
fer more or less severely from sickness and indisposition. 
But there were a number whose illness never confined them 
to their beds. Some were affected with slight chills and fe- 
vers, which were often readily subdued by a single emetic 
or cathartic ; many slight attacks were entirely removed in 
this manner. There were few, even of those who pursued 
their ordinary business, that were entirely free from every 
symptom of disease j generally the tongue was more or less 
furred ; in others there was a preternatural frequency of 
pulse, an impaired appetite and digestion, flatulency, colic, 
diarrhoea, catarrh, or some other deviation from perfect 
health. 

Some physicians have strenuously insisted on the specific 
nature of the yellow fever ; yet strange as it may appear, 
there are scarcely two, that, in describing the disease, agree 
as to the particular symptoms which constitute its peculiar 
diagnosis. The truth is that the yellow fever is nothing 
more than a high grade of the bilious remittent, which as it 
may be variously modified by a variety of causes, local in 
their origin, and changeable in their nature ; so in the same 
degree must the symptoms be liable to fluctuation and change: 
and we accordingly find, that wherever what is called the 
yellow fever has made its appearance in any of the seaports 
of the United States, the same fei er as an epidemic, though 
perhaps less malignant in its nature, has prevailed in vari- 
ous parts of the country at the same time. Thus, the bil- 
ious remitting fever which prevailed in Cahawba and its 
vicinity in the summer and autumn of 1821, and which in 
conformity to the modern nomenclature, with the strictest- 
propriety might be denominated the yellow fever, was like- 
wise generally prevalent, not only throughout the state of 
Alabama, but throughout the southern states, at the same 
time. It made its appearance not only in the seaports of 
Baltimore, Norfolk and Wilmington, but likewise in inland 
situations remote from any commercial intercourse. In 
certain situations more favorable than others to the full de~ 
velopement of its malignity, it assumed every formidable 
symptom of the so much dreaded yellow fever: in others it 
put on the character of a mild remittent, entirely free from 
malignity and danger; and in places still more favored.it 
appeared under the aspect of a quotidian or tertian intermit- 
tent, or what is commonly called c lit Us and fevers. That 
m all these instances there was a similarity in the origin and 



400 Bilious Remitting or Endemic Fever 0/I82I* 

nature of the epidemic, appears to be a matter too evident 
to admit of contradiction. And in further confirmation of 
this opinion, I would remark, that, with few exceptions, all 
who had labored under severe attacks of the bilious fe-er, 
were subsequently subject to chills and fev ers, or attacks 
of severe intermittents, some times continuing to recur 
throughout the winter. 

TREATMENT. 

Some difference of opinion existed among physicians as 
to the cure of this disease; and it is admitted that at different 
periods of the same season, different remedies seemed to be 
required, from a change in the features and symptoms of 
the complaint. . Thus, at an early stage of this disorder as 
an epidemic, the symptoms were less inflammatory and ma- 
lignant than they were later in the season ; so that the means 
which were found the most beneficial in one instance were 
not so well adapted in the other. 

Blood-letting. — Perhaps there was no means or remedy 
employed in this disease on which the opinion of physicians 
was so much divided as on this : though I believe it was 
generally remarked, that those who were the most violent 
in condemning it were those, who, from want of personal 
experience, were ignorant of its effects. It is true, that at 
the commencement of the sickly season, blood-letting was 
not so necessary as at a subsequent period : and, perhaps, 
there were but few at this time who absolutely required it: 
at least, as far as my own experience was concerned, the 
disease, at the commencement of the season, yielded with- 
out much difficulty to other remedies. The disorder after- 
wards, however, as has already been stated, became more 
inflammatory, with a great disposition to congestion, in- 
flammation and derangement of the brain, lungs, stomach,, 
bowels, liver, spleen, &c. To diminish the violent excite- 
ment of the heart and arteries, and to take off the tendency 
to local inflammations, venesection, in many cases, seemed to 
be absolutely required. Dr. Casey, an experienced and judi- 
cious physician of this place, as well as myself, can bear 
testimony to the importance of blood-letting in the treat- 
ment of this disease. The most proper time for the em- 
ployment of this remedy, was during the exacerbation of 
the fever, when the body was preternaturally hot, and the 
pulse full, strong and tense. The frequency or slowness 
of the pulse had less influence in governing the practice 
than its hardness and tension. I have known the pulse to 
indicate high excitement and considerable inflammation, 
with little or no preternatural increase of frequency \ but 



m 

Bilious Remitting or E&demic Fever a/1821. 4M 

the artery, in these cases, was hard, tense and resisting to 
the touch ; and when pressed against the tendons and liga- 
ments of the wrist, communicated a peculiar vibrating sen- 
sation to the fingers, like sand or gra^ el hurried along in 
the course of the circulation. Here blood-letting was im- 
mediately and copiously called for. In the employment of 
this remedy, it was necessary to be governed more by the 
effects produced than by the quantity drawn ; and it often 
happened that a tea-cupful of blood taken away at the com- 
mencement of the disease had a greater effect than four 
times the quantity at a subsequent period. I have known 
the abstraction of four ounces of blood at the commence- 
ment of the fever, when performed in the horizontal posi- 
tion of the patient, to produce so much sickness and langor 
as to render it necessary to stop the operation : notwith- 
standing the pulse, before the venesection, was frequent, 
strong and hard, the abstraction of this small quantity had 
the effect of rendering it much softer, and of reducing the 
morbid heat of the body to the natural temperature. In 
the course of a few hours after the first bleeding, it was 
not uncommon for the fever to rise considerably higher than, 
it was at the first ; the body would become excessively hot 
and dry, the pulse frequent and tense, and often accompa- 
nied with a iolent palpitation of the heart. Here blood- 
letting was again called for, and in more copious quantity 
than at first. Under these circumstances I have sometimes 
taken away a quart of blood at a single operation, and with 
the best result. 

The effects of blood-letting were to subdue or moderate 
pain, soften the pulse, stop the palpitation of the heart, re- 
duce the excessive heat of the body, remove the stricture of 
the surface, thereby opening the pores of the skin and pro- 
ducing perspiration ; from restlessness and anxiety, the 
patient was restored to ease and composure ; the oppres* 
sion of the brain was in a greater or less degree removed; 
the coma, morbid drowsiness and stupidity were relieved, 
and every symptom improved. 

I know it is a pre* alent opinion among physicians that 
bleeding in warm climates and sickly seasons should be em- 
ployed, or ventured upon, with the greatest caution. It is 
not in every epidemic, nor at every period of the same sea- 
son, that blood-letting is alike necessary and proper ; and 
in forming an opinion upon this subject, we are to be guided 
in our practice, by the circumstances already pointed out in 
the general treatment of endemic fever. When the epi- 
demic is of a malignant character, when the disease is a^- 
*3 



402 Bilious Remitting or Endemic Fever of 1821. 

vanced, when the pulse is destitute of strength, and when 
there are no indications of local inflammation or conges- 
tion, every prudent physician, under these circumstances, 
would hesitate in the employment of the lancet. But where 
the pulse is strong and tense, as it was during a considera- 
ble part of the epidemic under consideration, there is pro- 
bablv no remedy that we can employ with equal efficacy, 
advantage and success. In the yellow or bilious fever which 
prevailed in Philadelphia in 1793 and 1794, the pulse, as 
well as most of the other symptoms, was the same as that 
observed in the patients affected with the bilious fever in 
this place in the summer and autumn of 1821. And it is 
well known to what an extent Dr. Rush pursued the prac- 
tice of blood-letting in the fever of Philadelphia. His suc- 
cess, if we may judge from his own statement, as well as 
from the concurring testimony of others was astonishing 
and unequalled. * On the contrary in the year 1780, owing 
to the circumstance of the fever being less inflammatory, the 
same author informs us that blood-letting was followed by 
pernicious consequences. His words are as follows, "Out 
of several hundred patients whom I visited in this fever, I 
did not meet with a single case, before the 27th of Septem- 
ber in which the state of the pulse indicated this evacuation. 
It was true, the pulse wasjfo//, but never hard. I acknowl- 
edge I had been called to several patients who had been bled 
without the advice of a physician, who recovered afterwards 
on the usual days of the solution of the fever. This only 
can be ascribed to that disposition which Dr. Cleghorn at- 
tributes to fevers to preserve their types under every vari- 
ety of treatment as well as constitution. But I am bound 
to declare further, that I heard of several cases in which 
bleeding was followed by a fatal termination of the dis- 
ease."! Dr. Rush seldom ordered more than ten ounces 
of blood to be extracted at a single bleeding ; but he often 
repeated the operation two or three times a day ; and from 
several of his patients in the bilious fever of 1794 he ex- 
tracted 150 ounces of blood in the course of the disease. 
He lays considerable stress upon this method of blood-let- 
ting, in preference to more sudden and copious depletion. 
The doctor illustrates this practice of small bleedings by a 
reference to the disease in South- Carolina, known by the 
name of the pleurisy in the head, which occurs in the winter 
after a sickly autumn, and seems to be an evanescent symp- 

* Med. Inq. & Obs. Phil. ed. 1809, Vol. S 
| Med. Inq- & Obs. Vol. 2, p. 393 . 



Bilious Remitting or Endemic Fever of 1821. 40,3 

torn of the bilious remitting fever. Bleeding we are infor- 
med was employed in its treatment in the common way, 
and without success ; though the remedy succeeded in an- 
other mode, and that was by obtaining the discharge of a 
few ounces of blood from the nose by thrusting a piece of 
quill up the nostrils. Riverius describes a pestilential fe- 
ver, which prevailed at Mont-Pellier, in the year 1623, 
which carried off one half of all who were affected by it j 
this judicious physician prescribed the loss of two or three 
ounces of blood. The pulse rose, he informs us, with this 
small evacuation. Three or four hours afterwards he drew 
six ounces of blood from his patient, and with the same 
good effect. The next day he gave a purge, which he says 
rescued his patients from the grave. All whom he treated 
in this manner recovered. " The whole history of the epi- 
demic," says Dr. Rush, who quotes the above passage, u is 
highly interesting, from its analogy with our late epidemic 
(of 1793) in so many of its symptoms, more especially as 
they appeared in the different states of the pulse. "# And 
from my own experience, I can say, that small bleedings 
only or chiefly were admissible in the first stages- of 
the bilious fever of this place in 1 821 . At a subsequent pe- 
riod of the disease, however, I often found large evacua- 
tions necessary ; and on these occasions I have taken away 
20 or 30 ounces of blood at a time, before any very sensible 
alteration could be made in the pulse. The effects of blood 
letting upon the heart and arteries varied in different pa* 
tients. When the pulse was very frequent before the bleed- 
ing, it became slower after the operation ; when there was 
little or no preternatural frequency previous to venesection, 
it became somewhat accelerated subsequent to the loss of 
blood. But in every case the tension or hardness was more 
or less removed, and the febrile heat as well as the pains 
which affected different parts of the body diminished, and a 
remission commonly followed in a short time. I have some- 
times had recourse to the employment of this remedy as 
late as the second week, from the commencement of the 
disease, and with the best effect. Bleeding was as service- 
able, we are informed by Dr. E. H. Smith, in the yellow 
fever of New- York in 1795, on the 5th and 6th days, as on 
the first ; but that this necessity for its use at so late a pe- 
riod, did not often occur where it had been vigorously em- 
ployed in connexion with the other remedies at first. f 

* Inq. and Obs. Phil. Ed. 1809. Vol. 3, p. 275. 

~ Websters's collection, of papers on bilious fevers, p. 131, 



4D4 Bilious Remitting or Endemic Fever of 1821. 

In cases where blood-letting was not required, I com* 
menced the cure by the exhibition of an emetic. This, in 
ordinary cases, consisted of tartarised antimony. My me- 
thod of giving it was to dissolve from six to ten grains of 
this medicine in about half a pint of warm water, directing 
the patient to take about one-fourth of this mixture at the 
first draught, and should this not prove sufficient, in the 
course of fifteen or twenty minutes to repeat it, in the quan- 
tity of a table spoonful every ten minutes, till it produced 
five or six operations by vomiting. Given in this way it 
commonly acted both as an emetic and cathartic. During 
its operation as an emetic the patient was directed to drink 
copiously of warm water, and when it acted upon the bow- 
els to take freely, from time to time, of thin gruel or toast 
water : which answered a double purpose as assisting the 
operation of the medicine, and supporting in some degree, 
the strength of the patient. Though emetics were highly 
serviceable in this disease, some caution was necessary in 
their employment ; for where a considerable dose of tartar 
emetic had been taken and it produced little or no opera- 
tion as an emetic, it was liable to act as an excessive and 
violent cathartic : in which cases I have known an alarming 
prostration to ensue as the consequence. This sudden pros- 
tration, which I have previously noticed when treating of 
the symptoms of this disease, not unfrequently happened 
even from the exhibition of emetics in ordinary doses ; but 
when occuring at an early stage of the disease, I never found 
much difficulty in removing it by the timely application of 
stimulating remedies ; such as warm brandy toddy, wine 
sangre, and hot applications to the extremities. Though 
the stomach was sometimes operated upon with difficulty 
by emetics, yet it sometimes happened that a single spoon- 
ful of the solution of tartar emetic, previously mentioned, 
was sufficient to excite a free and copious vomiting. This 
seemed to be owing to the quantity of bile and vitiated flu- 
ids in the prima? via? oppressing and nauseating the stom- 
ach, and which, therefore, required but little to excite it in- 
to action. The quantities of green and yellow bile discharg- 
ed in this way were sometimes immense and astonishing. 
Making allowance for the drink taken in, I think I shall 
speak within bounds when I say that I have seen nearly 
half a gallon of green, ropy, bitter nauseous fluid discharg- 
ed from the stomach by the operation of a single emetic. 
From this we may judge of the necessity and importance 
of this remedy in this disease : for cathartics, however 
drastic, were not equally effectual in emulging and unload* 



BUious Remitting or Endemic Tetter oflSSt. 405~ 

ing the hepatic system, and thereby promoting the expul- 
sion of the stagnating vitiated fluids. Provided the emet- 
ic operated well I did not generally repeat it at any subse- 
quent period. Sometimes, however, such a repetition was 
indicated by the sickness and oppression of the stomach, 
bitter taste and foul tongue ; under these circumstances e- 
metics were again had recourse to with advantage. Even 
in the latter stage of this disease, when the person complain- 
ed of an increased nausea of the stomach, I sometimes pre- 
scribed this remedy with relief and benefit to the patient; 
it generally brought away more or less of a bright green 
colored matter, of a flaky appearance ; which was thrown 
-up with but little effort of vomiting, and appeared to have- 
been floating among the contents of the stomach. The dis- 
charge of this poisonous looking stuff always afforded con- 
siderable relief. In the employment of emetics it was ne- 
cessary to attend to the cautions already pointed out, under 
the general treatment of fever, pages 311 and 312. Ipecac, 
or the sulphate of zinc was safer in the advanced stage of 
the disease. 

After the operation of the emetic, a cathartic was exhibi- 
ted. In many cases, however, it was necessary to defer the 
purgative a few hours after the emetic had ceased to oper- 
ate, otherwise the system might be too much debilitated by 
the operation of the two remedies" in immediate succession: 
but upon this subject I have given particular directions un- 
der the general treatment of fever. As there is a constant 
reproduction of bile in this disease, the accumulation of 
which is known to aggravate the complaint, the necessity of 
employing cathartics must be sufficiently manifest : and as 
the bow T els are liable to be very much constipated in bilious 
disorders, it is necessary that the purgatives employed 
should be of the most active kind,in order to ensure their ef- 
fects, this at least was necessary in the disease under con- 
sideration. In the treatment of the bilious remitting fever 
of Philadelphia in 1796^ Dr. Rush, next to bleeding, placed 
his principal dependence in purgative medicines. The dis- 
ease at that time was new to him, and his first attempts to 
stop its ravages were fruitless and unavailing. As the cir- 
cumstances which led to his subsequent practice are inter- 
esting andlinstructive, I will here quote them for the benefit 
of the reader. " Baffled in every attempt to stop the rava- 
ges of this fever, I anticipated all the numerous and com- 
plicated distresses in the city, which pestilential diseases 
have so often produced in other countries. The fever had 
& malignity and obstinacy \v r hich I had never before observ- 



406 Bilious Remitting or Endemic Fever o/'1821. 

ed in any disease, and it spread with a rapidity and mortal- 
ity far beyond what it did in the year 1762. Heaven alone 
bore witness to the anguish of my soul in this awful situa- 
tion. But I did not abandon a hope that the disease might 
yet be cured. I had long believed that good was commen- 
surate with evil, and that there does not exist a disease for 
which the goodness of Providence has not provided a rem- 
edy. Under the impression of this belief I applied myself 
with fresh ardor to the investigation of the disease before 
me. I ransacked my library, and pored over every book 
that treated of the yellow fever. The result of my resear- 
ches for a while was fruitless. The accounts of the symp- 
toms and cure of this disease by the authors I consulted 
were contradictory,and none of them appeared altogether ap- 
plicable to the prevailing epidemic. Before I desisted from 
the inquiry to which I had devoted myself, I recollected 
that I had, among some old papers, a manuscript account 
of the yellow fever as it prevailed in Virginia in the year 
1741, which had been put into my hands by Dr. Franklin, 
a short time before his death. I had read it formerly, and 
made extracts from it into my lectures upon that disease. 
I now read it a second time. I paused upon every sentence \ 
even words in some places arrested and fixed my attention. 
In reading the history of the method of cure I was much 
struck with the following passages. 

" It must be remarked, that this evacuation (meaning by 
purges) is more necessary in this than in most other fevers* 
The abdominal viscera are the parts principally affected in 
this disease, but by this timely evacuation their feculent 
corruptible contents are discharged, before they corrupt and 
produce any ill effects, and their various emunctories and se- 
cerning vessels are set open, so as to allow a free discharge 
of their contents, and consequently a security to the parts 
themselves, during the course of the disease. By this eva- 
cuation the very mineraof the disease, proceeding from the 
putrid miasmata fermenting with the salivary, bilious, and 
other inquiline humours of the body, is sometimes eradica- 
ted by timely emptying the abdominal viscera, on which it 
first fixes, after which a gentle sweat does as it were nip it 
in its bud. Where the primse vise, but especially the stom- 
ach, is loaded with an offensive matter, or contracted and 
convulsed with the irritation of its stimulus, there is no 
procuring a laudable sweat till that is removed ;. after which 
a necessary quantity breaks out of its own accord, these 
parts promoting it when by an absterging medicine they 
are eased of the burden or stimilus which oppresses them," 



Bilious Remitting or Endemic Fever of 12,21. 4&7 

" All these acute putrid fevers ever require some evacua- 
tion to bring them to a perfect crisis and solution, and that 
even by stools, which must be promoted by art, where na- 
ture does not do the business herself. On this account an 
ill-timed scrupulousness about the weakness of the body is of 
bad consequence in these urging circumstances ; for it is 
that which seems chiefly to make evacuations necessary, 
which nature ever attempts, after the humours are fit to be 
expelled, but is not able to accomplish for the most part in 
the disease ; and I can affirm that I ha* e given a purge in 
this case, when the pulse has been so loxv that it could hard- 
ly be felt, and the debility extreme^ jet both one and the oth- 
€r, have been restored by itP 

"This evacuation must be procured by lenitive chologoque 
purges." 

"Here I paused," says Dr. Rush. "Anewtrain of ideas sud- 
denly broke in upon my mind. I believed the weak and low 
pulse which I had observed in this fever, to be the effect of de- 
bility from a depressed state of the system, but the unsuccess- 
ful issue of purging, and even of a spontaneous diarrhoea, in a 
patient of Dr. Hutc'hinson, had led me not only to doubt of, 
but to dread its effects. My fears from this evacuation were 
confirmed by the communication I had received from Dr. 
Stev ens. I had been accustomed to raising a weak and low 
pulse in pneumony and apoplexy, by means of blood-letting, 
but I had attended less to the effects of purging in produc- 
ing this change in the pulse. Dr. Mitchell in a moment 
dissipated my ignorance and fears on this subject. I adopt- 
ed his theory and practice, and resolved to follow them. It 
remained now only to fix upon a suitable purge to answer 
the purpose of discharging the contents of the bowels. I 
have before described the state of the bile in the gall-blad- 
der and duodenum, in an extract from the history of a dis- 
section made by Dr. Mitchell. I suspected that my want 
of success in discharging this bile, in several of the cases 
in which I attempted the cure by purging, was owing to 
the feebleness of my purges. 

"Finding ten grains of jalap insufficient to carry the cal- 
omel through the bowels in the rapid manner I wished, I 
added fifteen grains of the former to ten of the latter ; but 
even this dose was slow and uncertain in its operation. I 
then issued three doses, each consisting of fifteen grains of 
jalap and ten of calomel ; one to be given every six hotirs 
until they procured four or five large evacuations. The ef- 
fects of this powder not only answered, but far exceeded 
my expectations. It perfectly cured four out efth&ftfst 



408 Bilious Remitting or Endemic fever 0/I82I* 

five patients to whom I gave it, notwithstanding some of 
them were advanced several days in the disease. 

"There is, in all bilious fevers, a reproduction of morbid 
bile as fast as it is discharged. I therefore gave a purge 
everv day while the fever continued. I used castor oil, 
salts, cremor tartar, and rhubarb (after the mercurial purges 
had performed their office), according to the inclinations of 
my patients, in all those cases where the bowels were easi- 
ly moved ; but where this was npt the case, I gave a single 
dose of calomel and jalap every day. Strong as this purge 
may be supposed to be, it was often ineffectual ; more es- 
pecially after the 20th of September, when the bowels be- 
came more obstinately constipated. To supply the place of 
the jalap, I now added gamboge to the calomel. Two grains 
and a half of each, made into a pill, were given to an adult 
every six hours, until they procured four or five stools." 

The iews of Dr. Rush in relation to the bilious fever of 
Philadelphia I conceive to be perfectly applicable to the 
disease under consideration ; and as his name stands de- 
servedly high in his profession, his authority may be more 
respected than that of an individual less known. Obstinate 
constipation of the bowels was not peculiar to the fever of 
Philadelphia, the same thing takes place to a greater or less 
degree in all bilious epidemics, and was particularly re» 
markable in the bilious fever of this place in 1821. Such, 
frequently , was the degree of constipation in this disease, that 
it was with the greatest difficulty medicine could be made 
to act upon the bowels, though assisted in its operations by 
the frequent use of enemata. Fifteen grains of calomel 
with twenty-five of jalap might, in general be considered as 
a moderate dose ; and this, or some other cathartic, often 
required to be repeated together with injections before an 
.evacuation could be procured. Jalap and cream of tartar 
was generally as certian and efficacious as a cathartic. 

I commonly gave calomel pretty freely in the early stage 
of this disease, both to render the bowels soluble, and to 
remove obstructions. These objects were materially pro- 
moted by the exhibition of this medicine. I have knownsalts 
and castor oil, by themselves to go through the bowels with- 
out occasioning any thing more than a thin watery discharge; 
but in such cases the addition of calomel to some active ca- 
thartic produced copious, feculent and bilk^us evacuations. 
The repeated exhibition of calomel for the purpose of keep- 
ing; up the action of the bowels sometimes occasioned sore- 
ness of the gums ; and when this was at the same time at- 
tended with a soft and moist skin, it was a. favorable symp- 



Bilious Remitting" or Endemic Fever of 1821. 409 

torn. In general, I found the disease to yield more readily 
after the gums became affected by mercury ; though on 
some occasions, I have, I think, observed a contrary effect ; 
but the latter only or chiefly happened when the skin was 
dry, parched and hard, and never moistened by the appear- 
ance of sweat. In such cases the pulse would continue fre- 
quent, tense, and wiery, and the throat become dry, parched 
and painful. Though the gums were swelled and inflamed, 
the patient was not inclined to spit, but on the contrary com- 
plained of constant dryness of the mouth and throat, I 
never intentionally pushed the exhibition of calomel to the 
point of salivation, though I often gave it in sufficient 
quantity to produce a degree of redness and swelling in the 
gums. But where there was much debility or danger of 
prostration I deemed it proper to avoid the use of calomel 
altogether. 

A great point in the treatment of bilious fever is to keep 
the bowels thoroughly cleansed, and free from all accumu- 
lations of bilious, excrementitious, and offensive matters 
which are incessantly poured into them, and therefore re- 
quire to be constantly removed by the exhibition of the ap*. 
propriate remedies, such as cathartics and injections. Where 
the mouth was affected from the exhibition of calomel pur- 
ges, glauber or epsom salts were exhibited, as occasion re- 
quired. As it frequently happened that great irritability of 
the stomach existed, which rendered it almost impossible to 
retain any bulky medicines, we were obliged to have re- 
course to those which were least offensive. On this account, 
Epsom and Rochelle salts, or the phosphate of soda were 
found to agree better than Glauber's salts : and to prevent 
their being rejected, they were given in small doses, fre- 
quently repeated, say every hour, or half hour, until a suf- 
ficient quantity had been taken to operate freely, two, three, 
or four times. Another thing was necessary to be kept in 
view, which was, not to put off the exhibition of purgatives 
till the time that they were absolutely required. If their 
exhibition was delayed under the expectation that nature, 
unassisted, would bring about an evacuation, the patient 
would suffer before the cathartic could be brought to act 
upon the bowels. It was, therefore, necessary to anticipate 
the time when the urgency of the symptoms might require 
the evacuations of the intestines without dela)^, by beginning 
with salts or other purgatives from four to six hours before 
hand. Some patients rejected medicine in any form except 
that of pill ; and as medicine in this form operates slowly, 
the more was required. In such cases, I have sometimes 
b3 



410 Bilious Remitting or Endemic Fever cf'182i. 

been obliged to direct the administration of as many as thir- 
ty pills of calomel and jalap, before any operation was pro- 
cured ; directing two or three to be taken every ten or fif- 
teen minutes, till the necessary quantity had been received. 
Injections were found to be of essential benefit. They 
could at any time be employed in cases of emergency ; and 
where restlessness prevailed, together with fever, and heat 
and pain in the bowels, their operation was followed by the 
most salutary and composing effect. This shows how much 
an irritation in the bowels extends itself to the whole nerv- 
ous system. These injections commonly brought away a 
considerable quantity of bilious and feculent matters. When 
an exacerbation ®f the fever came on, injections almost al- 
ways produced a mitigation of the symptoms ; thev likewise 
assisted the operation of cathartics taken bv the mouth. — 
Where much debility and prostration existed, prohibiting 
the use of cathartic medicines, injections became indispensa- 
bly necessary. Where considerable constipation prevailed 
and the patient was debilitated, injections were frequently 
repeated. This remedy was on some occasions employed 
with another view than that of remo'. ing costiveness ; it 
sometimes happened that the fever rose with violent pain 
and distress in the stomach and bowels ; nothing removed 
this symptom so soon and so effectuallv as an injection of 
warm water with a tea-spoonful or two of laudanum ; sufr 
fering it to remain a few minutes, and then bringing it away 
by a simple enema of warm water. When it was immedi- 
ately leturned, it became necessary to repeat the exhibition 
of laudanum. Opium exhibited in this way was entirely 
free from danger, as we had it completely at command: and 
on some occasions of great pain and irritation, in which 
bleeding had proved unavailing, I found it necessary to ex- 
hibit two ounces of the tincture before the distress and gri- 
ping could be materially relieved. 

The Cold Bath. — Cold bathing in the cure of fever is a 
means on which much diversitv of opinion has existed, nor 
are the physicians of the present day entirely agreed as to 
the utility of its employment. In this country it has never 
come into general use : and I believe there are but very few 
places in the United States where it is considered and em- 
ployed as a medical prescription. This may be accounted 
for from the influence of prejudice and want of experience 
amongst some, and from its employment under improper 
circumstances amongst others. It is possible and even pro- 
bable that in some epidemics, cold bathing may afford bu^ 
little benefit, or, indeed prove prejudicial ; such at least 



Bilious Remitting- or Endemic Fever of '1821. 411 

would be our conclusion were we to believe the accounts 
of several physicians who have written on the subject: and 
even in the course of my own practice, I have found that 
cold bathing is much less serviceable in the fevers of some 
seasons than it is in those of others. The weight of evi^- 
dence, however, among physicians who have written on the 
diseases of hot and tropical climates is in favor of cold 
bathing as a general remedy. Certain it is that in the epi- 
demic which prevailed in Cahawba and its vicinity in the 
summer and autumn of 1821, I saw in many instances, the 
most happy effects from the employment of the cold bath. 
In the use of this remedy it was necessary that several cir- 
cumstances should be attended to. To authorise its use 
there must be a preternatural increase of heat upon the sur- 
face of the body ; and the higher the temperature the more 
decidedly serviceable did it prove. The manner in which 
I employed it has been already mentioned under the gene- 
ral treatment of fever. When upon coming from the bath 
the person was laid in bed, as the temperature rose a free 
perspiration would frequently break out, to the great relief 
and benefit of the patient. Not unfrequently, however, the 
heat of the body would return in a short time without the 
appearance of a perspiration ; in such cases a repetition of 
the remedy became necessary. It was scarcely ever neces- 
sary to repeat the cold bath more than two or three times 
during the same paroxysm. 

The effect of this remedy was to diminish the heat of the 
body — relieve the pain in the head — stop the palpitation of 
the heart — moderate the frequency of the pulse, and render 
it more soft and natural — and to impart ease and cqmfort 
to the general system. 

It is a false and erroneous idea to suppose that cold ba- 
thing puts an immediate termination to the febrile paroxysm. 
The most it does is to produce a mitigation of the symp- 
toms, and to cause that change in the vascular and nervous 
systems favorable to the solution of the fever. It is certain 
that the cold bath has the power and effect of completely 
subduing the fever for a time, but I never saw an instance 
of its employment in which the fever did not rise, more or 
less, in a few minutes afterwards, and go through its usual 
stages. These observations are made in contradiction to 
the erroneous statements and unfounded speculations of 
Gianini,'^ that in intermittent fever, for the same remedy 
applies to the intermitting and remitting fevers, in both of 

* See Chapman's philda. Med ; & Phys, Jour.; vol. ii, p. 113.. 



.412 Bilious Remitting or Endemic Fever of 1821. 

which I have employed it with equal advantage, that in this 
disease the cold bath produces not a partial alleviation of 
symptoms but an entire solution of the disease, than which 
nothing is more unfounded and foreign to the fact. 

When the fever was protracted and obstinate, receiving 
but little benefit from the other remedies employed, the su- 
perior utility of the cold bath was then apparent, in fre- 
-quently bringing about a remission and establishing a state 
of convalescence. Where the skin was unusually dry, with 
but partial, or no appearance of perspiration, though the heat 
was but little increased above the natural standard, cold 
bathing was resorted to with evident advantage. In those 
cases of typhus or nervous fever which supervene up- 
on obstinate and malignant attacks of bilious fever, and in 
which the paroxysms were irregular and erratic, returning 
at no particular period, and where the remissions themselves 
"were obscure and scarcely perceptible, the fever rising and 
declining frequently through the day, in such cases the cold 
bath was employed with considerable benefit. 

Where the patient was too much debilitated to bear the 
shock of the cold affusion, warm water was substituted in 
its place ; or, in lieu of both, the body was sponged with 
warm vinegar, or diluted muriatic acid. The latter remedy 
possessed considerable power. 

The Warm Bath.— -Warm bathing was also sometimes 
advantageously employed, but the instances were compar- 
ath ely few in which its employment was necessary and pro- 
per. Where there was considerable debility, with unequal 
distribution of temperature, the feet being cold and the body 
warm, or where the warmth of the general surface was be- 
low the natural standard, warm bathing was sometimes em- 
ployed with advantage, care being taken not to exhaust the 
strength too much by too long a continuance in the water. 

"Where the fever and heat were not so high and uniform- 
ly diffused as to requiie or admit the use of the cold bath, 
relief was obtained by the topical applications of linen 
clothes, wet with cold vinegar and water, to the forehead, 
breast and extremeties, either at the same time, or as an un- 
equal degree of heat in any of these parts might render ne- 
cessary. The patient expressed great relief from these ap- 
plications, and their expediency was indicated by the exces- 
sive heat which was apt to prevail in particular parts of the 
body. Cold applications to the head, such as snow, ice, 
cold water and the claycap, are old and established remedies 
in phrenitis and mania ; and as there can be no doubt that 
the brain in cases of original and idiopathic fever is fre- 



Bilious Remitting or Endemic Fever of 1821. 41 S 

quently affected with a degree of inflammation, the same 
practice is sanctioned in this disease, both by theory and ex- 
perience. Whenever, therefore, the head was much affected 
linen clothes wet with the coldest water and frequently re- 
newed were applied until those symptoms were relieved. 

With the same view of relieving the congestion ard in- 
flammation of the brain, as indicated by pain in the head, 
redness of the eyes, derangement and alienation of mind a 
blister was applied to the forehead, the temples, or the nape 
of the neck. I have known patients who had remained stu- 
pid, lethargic and senseless for forty-eight hours in the bil- 
ious fever of 1821, to awake and recover the use of their 
intellect upon the drawing of a blister plaster applied to 
the head. 

Having dwelt pretty fully on the treatment of fever un- 
der the general head, it will not be necessary here to go in- 
to a particular detail and repetition of what has been alrea- 
dy discussed ; I shall, therefore, conclude by a few remarks 
upon such other remedies as were found particularly ser- 
viceable in the epidemic under consideration. 

As a febrifuge, cream of tartar and spirits of nitre, were 
given with advantage. As a common beverage the quan- 
tity of a tea spoon of cream of tartar might be taken dissol- 
ved in half a pint of water every two hours. W 7 hen the pa- 
tient was in a perspiration it was better to dissolve it in 
some warm herb tea, as more favorable to the process. 

The effervescing, draught of carbonate of potash, or soda 
and lime juice, or strong vinegar, was likewise a valuable 
febrifuge and diaphoretic : the latter was often given alter- 
nately with the medicine mentioned in the foregoing para- 
graph. 

Sometimes the febrifuge powders described under the 
general treatment were exhibited. 

In addition to the ordinary febrifuge remedies the daily 
use of purgatives was necessary, during the continuance of 
the fever ; proportioning their strength, quantity and qual- 
ity to the violence of the fever, and to the strength or debil- 
ity of the patient. It sometimes unfortunately happened 
that the debility was so great as to forbid the employment 
of laxatives in any form; the only thing that could be done 
towards cleansing the first^passages, in such cases, was the 
use of injections. Cases of this description were often despe- 
rate : on the one hand the foul state of the stomach and 
towels indicated the necessity of free and copious evacua- 
ions; and on the other, we were thwarted in our objec 1 by 
#ie existing debility of the patient: by careful management 



414 Bilious Remitting or Endemic Fever of '1821. 

life might be lengthened out and perhaps recovery estab- 
lished, when by a single purgative the patient might be ir- 
recoverably sunk. 

Where the fever was inconsiderable and disposed to as- 
sume the low nervous or typhoid character, with a dry skin, 
spirits of nitre and ammonia, or the spiritus mindereri 
and hartshorn, were employed with advantage ; of the for- 
mer, two parts of spirits of nitre and one of ammonia, a tea 
spoon full was given every hour or two hours as occasion 
required. As laxatives cream of tartar, tamarinds, senna 
and manna, epsom salts, and castor oil were severally given, 
varied according to the symptoms and the fancy of the 
patient. 

As a constant drink lemonade was more agreeable and 
useful than any other; tamarind water was also given as a 
febrifuge, and as a grateful and refreshing drink. 

Where the fever was slight, snake root tea was given with 
a view of promoting perspiration ; it was, however, care- 
fully avoided in cases of excitement, as forced sweats were 
always injurious. And here I would remark a frequent er- 
ror cf patients and attendants. Having ascertained that 
perspiration is a very desirable object with the phvsician, 
they erringly suppose that by whatever means this is effec- 
ted, the end and object are accomplished; than which no 
notion can be more erroneous. I have often had occasion 
to correct this error upon visiting my patients, finding them 
sweating under a load of bed clothes and the use of hot 
snake root tea, either from the persuasion and advice of 
some officious friend and attendant, or from their own no- 
tions and skill in therapeutics. At other times I have vis- 
ited patients in the heat of summer, and found them with a 
frequent, soft, and weak pulse, much alarmed,and complain- 
ing of profuse cold sweats, under a load of three or four 
blankets; not aware that the sweat proceeded from the 
quantity of bed clothes, they would scarcely be persuaded 
of the fact, till the covering being reduced to a single sheet 
or blanket, these cold, profuse and unnatural sweats disap- 
peared, and the pulse becoming reduced in frequency, rose 
in strength and fulness. Unskilful treatment is worse than 
none ; and many lives have been lost by injudicious man- 
agement, which if they had been left to themselves would 
have been preserved. 

The spirits of nitre alone was often a valuable medicine, 
both as a diuretic and diaphoretic. It sometimes haj- 
pened in this disease that the urine was small in quantity 
high colored and acrimonious, to remedy which acid dill- 



Bilious Remitting or Endemic Fever of\%2\. 415* 

ents and spirits of nitre were important and useful remedies. 
Their utility was rendered the more manifest by the aggra- 
vation of the symptoms upon their discontinuance. 

Having dwelt at length upon the use of acids, both of the 
mineral and vegetable kingdoms, under the head of the gen- 
eral treatment of endemic fever, I shall have occasion to 
"say but little here. The nitric, muriatic and vegetable acids 
were often given in malignant cases with much benefit and 
success. The mineral acids were sometimes inadmissable 
from their proving disagreeable to the patient and occasion- 
ing sickness and vomiting, unless so much diluted as to 
render them of little advantage. 

As it respects nourishment, during the recess or remis- 
sion of the fever, the patient's strength was supported by 
some light food, such as gruel, panada, arrow root, sago, 
jelly, ripe and preserved fruit, biscuit, toast, and vegetables 
of easy digestion ; any of which might be taken in modera- 
tion, and varied according to the inclination of the patient. 
When the fever receded entirely, more nourishing articles 
were permitted, and of these soft boiled eggs were as agree- 
able and wholesome as any. 

Temperance and caution in eating cannot be too often 
and forcibly impressed upon the patient. Indulgence of 
appetite is the besetting sin of invalids and convalescents; 
to guard against which they should consider it as a moral 
and religious duty. Temperance is the guardian handmaid 
ofhtalth; and although drunkenness is deservedly looked 
upon with digust and contempt, yet the luxurious feeder, 
who rises from the table with an oppressive load, scarcely 
considers his indulgence as a crime. 

Most of those who had labored under bilious fever were 
subsequently affected with the intermitting or remitting fe- 
vers, of irregular types — rarely assuming the features of 
a distinct tertian ; and both in severity and character there 
was every variety, from the slightest chill and fever to the 
most inveterate ague. Some patients were regularly attack- 
ed every day about the same hour with a slight chill, suc- 
ceeded by a fever of different duration in different persons. 
For the cure of these secondary and irregular attacks the 
same remedies were required as for the original cases of fe- 
ver and ague; of these bark was the principle. The returns 
of chills and fevers were prevented by opiates and warm 
teas, in the manner already pointed out. 

Several West India writers have extolled the efficacv of 
travelling and the exercise of a carriage in the cool of the 
day, and under the coycrt of a shady wood, as of singular 



416 Bilious Remitting or Endemic Fever of 1821. 

efficacy in the cure of the fe ers of tropical climates. T6 
this I would remark that the same means, are often pro- 
ductive of very different results ; and as it regards my own 
experience I can bear testimony to the injurious and some- 
times fatal consequences of travelling even for a short dis- 
tance, and in the most easy mode of conveyance, while the 
patient is labouring under a fever, or is in a state of much 
de::i!ity and exhaustion: and the friends of Mr. Perkins 
will long ha \ e occasion to lament his imprudence in leaving 
his chamber in the first stage of con alescense, from a se- 
vere attack of bilious fever, and attempting to go home: 
his slender remains of strength became exhausted after ri- 
ding a mile and a half in a carriage; and the lapse of a few 
days put a period to the life of this worthy, respected, and 
amiable young man, 



AN ACCOUNT 



OF THE 



BILIOUS REMITTING OR ENDEMIC FEVER, 



AS IT APPEARED 



IN CAHAWBA AND ITS VICINITY, 



IN THE 



Summer and Autumn of 1822. 



AN ACCOUNT, &c. 



Early in the spring, we were visited by the measles., 
which, in general, however, were not of a malignant kind . 
The effervescence or eruption was a general diffused red- 
ness over the whole surface of the body; and sometimes 
cough, hoarseness, coriza and inflammation of the eyes took 
place a week before the eruption made its appearance. Just 
before the eruption, the symptoms became now severe, at- 
tended with a pain in some part of the chest, often in the 
side, and a cough, in so much, that at this stage it was diffi- 
cult to distinguish the disease from an attack of plurisy 5 
which prevailed at the same time in persons who had pre- 
viously passed through the measles, and which seemed to 
bepwing to the same state of the atmosphere that gave rise 
to the former complaint. 

The measles was not confined to children alone, but at- 
tacked several persons of mature age. 

In the treatment of this complaint, bleeding was some- 
times required, more especially in adults, and when pleu- 
ritic and inflammatory symptoms existed in a considerable 
degree. Emetics and laxatives were also serviceable; tar- 
tarised antimony, calomel and castor oil, were employed. 
In some, the application of blistering plasters to the side 
became necessary, in order to relieve the pain. As an ex- 
pectorant, a mixture of vinegar of squills, paregoric, spi~ 
rits of nitre, and a small proportion of antimonial wine^ 
was employed with singular efficacy. 

Upon the subsidence of the measles as an epidemic, the 
hooping cough made its appearance among children, in a 
form of considerable violence/ The symptoms were miti- 
gated, and the disease shortened by exhibiting daily, or at 
times when the cough was violent, an emetic of white vi- 
triol and alum. 

Before the disappearance of the measles and the hooping 
cough, and towards the last of June, the bilious fever began 
to prevail. The earlier appearance of the fever this season 
than usual, was probably owing to the extreme heat in the 
early part of summer. There had also been a considerable 
quantity of rain, by which the country had been much 
drenched, and filled with ponds of stagnating water. The 
month of June, however, was excessively hot and dvy s© 






420 Bilious Remitting or Endemic Fever of 1822. 

that the crops were much injured by the drought. The 
temperature of the weather was higher in June than in the 
succeeding months of July and August : for several days 
successively the mercury in Farenheit's thermometer ranged 
between 93 and 96° in the shade, during the heat of the day. 
The nights also, were excessively warm and uncomfortable. 
The fever in June was of a considerably high inflammatory 
character. The pulse was hard, and the fever was attended 
with pain in the head, nausea, great heat in the skin, with 
a disposition to derangement and alienation of mind. 

The epidemic this season, in Cahawba, was considerably 
less malignant than it was in the preceding : the same thing, 
however, was not observed in other places. In many parts 
of the country the disease was marked with unusual malig- 
nancy and fatality ; and places where the disease during the 
preceding season was mild and free from danger, were, in 
many instances, this season, afflicted with the epidemic un- 
der a character highly malignant. 

Though there was in the preceding season a considerable 
share of sickness in various parts of the United States, yet 
the malady of 1822 was far more general and extensive. — 
Places which had hitherto been considered unusually heal- 
thy, and had from their first settlement remained entirely 
exempt from disease, shared this season in the desolating 
and wide spread epidemic. 

As the heat and peculiarity of seasons favorable to the 
production of yellow fever is not confined to one particular 
town or settlement, but prevails o^er an extensive range of 
country, so, in like manner, when sickness rages with ma- 
lignancy in one place, the same general causes will spread 
the calamity over an extensive tract ; acting with peculiar 
force wherever the physical condition of the country is such 
as to favour and promote their operation. This fact has 
been generally observed ; and in the destructive yellow fe- 
ver which prevailed in Philadelphia in 1793, it was remark- 
ed that a similar disease prevailed at the same time at Lynn, 
in Massachusetts ; at Weathersfield and Coventry, in Con- 
necticut ; at New Galloway, in the state of New- York ; 
on Walkill and Pensocken Creeks, in New-Jersey ; at 
Harrisburgh and Hummelstown, in Pennsylvania ; in Ca- 
roline County, Maryland ; on the south branch of the Po- 
tomac in'Hardie County ; also, at Lynchburg and at Alex- 
andrian. Virginia ; and in several counties in North-Ca- 
rolina.* 



*Rush. Xnq. and Obs. Vol. 3. p. 2G1— 2, 



Bilious Remitting or Endemic Fever of 1822. 42 i 

Pensacola, which had hitherto been considered as a place 
of unusual healthiness, was this season visited by the bil- 
ious fever in a character of unusual malignancy : so that 
the city in the course of a few weeks was almost entirely de- 
populated by death and desertion. It was pretended by the 
advocates and friends of imported contagion, that the fe- 
ver was brought in a vessel which arrived from New-Or- 
leans about the beginning of August. The captain of this 
vessel was among the first that sickened and died of the 
malignant fever ; and this, after his arrival in Pensacola : 
but as well for his own comfort as from the fear of conta- 
gion, he had, in the first of his illness, been removed about 
a mile and a half from the town to an elevated and healthy 
situation in the country. " It appeared on enquiry," says 
the board of health, u that he had been for ten days en- 
gaged in getting off a brig, which had been cast on shore 
near the Barancas, and during that time he had been conti- 
nually exposed to the hot sun" — the vessel was extremely 
foul, and the smell on board of her intolerable. Subse- 
quently, there occurred the case of a young lady, who was 
taken ill about twelve days after her arrival from New-Or- 
leans, and who also died of a malignant fever. Now, it is 
very possible, and even probable, that the captain above 
spoken of, took the fever from the vessel which had been 
endeavoring to get off ; but as it does not appear that the 
vessel which arrived from New-Orleans was either foul or 
unhealthy, we must suppose that the young lady above al- 
luded to, took the infection after her arrival in Pensacola, 
and from the common source by which it was communica- 
ted to others. Nor would it be reasonable for the advo- 
cates of quarantine laws to suppose that where those salu* 
tary regulations are so strictly enforced as they are in New 
Orleans during the summer season, that the disease could 
be imported from thateden of health, where the strong and 
salutary arm of authority and law, like a guardian angel, 
holds the sword of protection for the safety and preserva- 
tion of the people. The opinion of one of the most res- 
pectable physicians in Pensacola was, that the disease origi- 
nated entirely from local causes. Such, also, was the con- 
viction of the board of health, who forthwith appointed a 
committee to search out and remove all nuisances ; one of 
which was a large quantity of semi-putrid and offenrive 
fish kept by the merchants, and in the neighborhood of 
w r hich the disease prevailed. Other causes, such as filthy 
lots, mud holes, &c. also existed ; so that instead of en- 
deavoring to seek a foreign source for this alarming and 



42'£ Bilious Remitting or Endemic Fever of\%22. 

destructive epidemic, in this, or in every other instance we 
find its origin at home. It is not presumed that such a 
knowledge and disclosure of facts can have a more injuri- 
ous influence upon the settlement and improvement of Pen- 
sacola or any other place, than if it were contended that the 
disease was merely accidental and imported. On the con- 
trary, the reverse may more rationally be expected ; for 
what is p'Tr.en by the most rigid enforcement of the qua- 
rantine regulations ? Have they ever prevented the appear- 
ance and prevalence of the yellow fever in places where 
physical causes conspired to produce it ? Let New-Orleans 
and the various cities and seaports of France, Spain and 
Portugal, decide the question. When the Catalinic and in- 
cendiary, who would scatter around him fire-brands, ar- 
rows and death, and spread ruin and conflagration through 
the city is within its walls, what would be the situation of 
the people, if, instead of searching out and detecting the 
domestic danger which they harbored among them, they 
should dread and expect their impending ruin from abroad? 

The operations of nature, to a certain degree, are subjeet 
to the controul and influence of man ; and it is only by an 
attention to the domestic and physical condition of our ci- 
ties and towns, as well as to the state and situation of our 
settlements, that we can expect to derive any advantage in 
the improvement of health and the prevention of disease.. 
The way in which this improvement is to be effected, I 
have already pointed out. 

The visitation of 1822, Was not the first time that the yel- 
low fever has prevailed in Pensacola. It prevailed there 
as long ago as 1765, when in possession of the British; 
where, as in 1822, its origin was altogether referable to lo- 
cal causes ; for we are informed by Dr. Lind, that the 
ships lying in the harbour, at the distance of a mile, were 
perfectly healthy. The observations of Dr. Lind upon 
this subject, will be found interesting, as well from their 
domestic relation, as from the intrinsic merit which cha- 
racterises the writings of this judicious and scientific phy- 
sician. "At Pensacola," says Dr. Lind,^ " where the 
soil is sandy and quite barren, the English have suffered 
much by sickness ; some, for want of vegetables, died of 
the scurvey ; but a far greater part of fevers. The exces- 
sive heat of the weather has sometime produced in this 
place a severe fever, similar to that which in the West In- 
dies goes under the name of the yellow fever. This, in the 

*0n the Diseases incidental to Europeans in Hot Climates, p, 26 } , 



Bilious Remitting or Endemic Fever of 1822. 423 

year 1765, proved very fatal to a regiment of soldiers sent 
from England, unseasoned to such climates, from the un- 
fortunate circumstance of their being landed there in the 
height of the sickly season. It raged chiefly in the Fort, 
where the air, in the soldiers' barracks, being sheltered from 
the seabreeze by the wall of the Fort, was extremely sultry 
and unhealthy. And it is worthy of remaik that during the 
fatal rage of this fever at Pensacola, such as lived onboard 
the ships in the harbour escaped it." In page 171, of the 
same work, he again resumes the subject: " Lately (in 1 765) 
when a mortal sickness prevailed at Pensacola, by which a 
regiment lately arrived there lost 120 men, and eleven out 
of twelve of the officer's ladies, who were landed with them, 
were said to have died; the companies of the men of war 
lying at a mile's distance from the shore, enjoyed the most 
perfect health. These ships were the Tartar and Prince 
Edward, of whose men those only who had been on shore, 
were siezed with this malignant fever, and all of them re- 
covered when they got on board. It was likewise remarka- 
ble that such gentlemen as were' siezed with this fever at 
Pensacola, and were carried on board ships, generally re- 
covered; or at least, by this change of air, the fever being- 
divested of its most mortal symptoms soon assumed the 
form of an intermittent. Pensacola, however, is of late es- 
teemed more healthy than Mobile, where intermitting fe- 
vers prevail in the months of July, August and September. 
For these fevers, both in this and the other American colo- 
nies, we shall in general observe that the bark has been 
found a sovereign remedy, and ought to be administered on 
the first remission of the fever, as on its early administra- 
tion will greatly depend the preservation of the patient's 
constitution." 

We are informed by the same author that in the year 1 766, 
sixteen protectant families, consisting of sixty persons were 
sent, at the expense of the government to West Florida. 
The ground allotted for their residence was on the side of 
a hill surrounded with marshes, at the mouth of the river 
Scambia. These new planters arrived in the winter, and 
continued perfectly healthy until the sickley months, (July 
and August.) About that time eight gentlemen, from one 
of whom Dr. Lind received his information, went to this 
new settlement to solicit votes for the election of a repre- 
sentative in the general assembly of the Province ; by re- 
maining but one night every one of them was siezed with 
a violent intermitting fever, of which the candidate for be- 
coming a representative, and another of their number died, 



424 Bilious Remitting or Endemic Fever of 1822. 

The next day seven other gentlemen came upon the same 
business to this unhealthy spot; but by leaving it before 
night they escaped the sickness and all continued in perfect 
health. Among the French settlers during those two 
months, the annual fever of the climate proved so fatal on 
this unwholesome spot, that of sixty persons, fourteen only 
survived; and even those who remained alive in the Sep- 
tember and October following, were all in a veiy ill state 
of health ; not one of them had escaped an attack of the fe- 
ver, and most of them died within a few months afterwards, 
from the injury it had done their constitutions.* Dr. Lind 
recommends the removal from an infected to a healthy place, 
as from shore to ship board, or from the low grounds of 
swamps to the hills, on the first invasion of fever, as being 
perfectly safe, and highly beneficial in mitgating and short- 
ening the disease. 

Similar causes to those which aided in producing the yel- 
low fever of Pensacola in 1822, as great quantities of spoil- 
ed fish, beef, and other articles of a perishable nature, also 
contributed towards the production of the yellow fever in 
New- York in 1798.J 

Extensive, accurate and general observation have con- 
firmed, beyond the power of contradiction, the truth of the 
following circumstance in the philosophy and physiology of 
nature, that the destruction of trees and forests, which takes 
place upon the first settlement of a country, is highly inju- 
rious to the health of the inhabitants. This circumstance 
will serve to explain why various parts of Alabama which 
had proved previously healthy, were in the summer of 1822 
visited with the prevailing epidemic. The settlement of 
one or two families in the uncultivated woods of the same 
vicinity, for the first year or two remains exempt from dis- 
ease : but when the settlement has considerably increased, 
and the destruction of timber become general and extensive, 
such places are rendered extremely unhealthy. This is 
liable to happen not only in the vicinity of creeks and riv- 
ers, but also in places removed beyond the influence of any 
stream or ponds of stagnating water ; in situations which to 
the eye of attentive observation afforded every recommen- 
dation and prospect of health. Such places have again been 
known to become healthy a second time, in the course of a 
few years. The philosophy of this phenomenon has, I be- 
lieve, been already explained in the preceding part of this 

* On the Diseases incidental to Europeans in Hot Climates, 
t See Dr, Bayley's letter, Med. Repos. vol, 2, p. 289, 



Bilious Remitting' or Endemic Fever of 1822. 4"2£ 

work, and may be briefly accounted for in the following 
manner. When, by the process of cultivation, and by expo- 
sure to the sun and air, the soil has lost a portion of the 
light decomposible or corruptible matter which abounded 
in excess upon its first clearing, and when the timber which 
had been killed is entirely destroyed and consumed, as the 
sources of decomposition are thus lessened, the atmosphere 
recovers again its former purity. The facts to which this 
explanation refers are too fully established by accurate ob- 
ser ation to admit of being called in question. Nor can it 
be reasonably objected that because we are unable, in every 
instance, to account for the origin of fevers and epidemics, 
we are therefore necessarily ignorant of their nature and ori- 
gin altogether. Much, undoubtedly remains to be discoV* 
ered ; but it does not follow that because we are not masters 
of the entire scope of medical science, we should therefore 
reject even the little that is established with all the support 
and authority of probability and truth. 

I have in some instances remarked that those who had la- 
bored upon se\ ere attacks of the bilious fever one season, 
were exempted from the influence of the prevailing epidemic 
in the subsequent year. This, however, is not a general 
rule; as I have known many to sicken, and not a few to die 
of the bilious fever, after repeated attacks of the disease for 
several years successively. 

If the bilious, or yellow fever were, like the small pox, 
liable to affect a person but once in the course of his life, 
the ravages of this ende&iic scourge of hot climates would 
be diminished in a tenfold proportion, and its destructive 
effects would be confined almost entirely to strangers and 
to emigrants from healthy climates : whereas it now makes 
little. distinction, for although persons lately arrived from* 
the cool salubrious regions of the north are the greatest 
sufferers, yet the native and ancient residents are also its 
frequent victims. 

The symptoms of the disease this season were much the 
same as in that of the preceding. The comparative malignity 
of the fever between the town and country was reversed 
from what it was in 1821. At that time the epidemic was 
more malignant in the town than in the neighboring coun- 
try; in 1822 the fever was milder in the former than in the 
latter situation. 

There were but about six or seven weeks during the lat* 
ter part of the summer that I was able to pay much atten- 
tion to practice. From fatigue and exposure in the discharge 
of mv nrofr-ssional calling, I was taken ill earlv in the s«v? 
• j>3 ' r 



426 Bilious Remitting o'r Endemic fever of 1%%2. 

son, and frequent relapses confined me to the house the 
greater part of July and August. I, however, saw and ex- 
perienced enough of the sickness to gain a pretty correct 
knowledge of its character and appearance, as well in the 
town as in the country. 

Yellowness of the skin, so common in the fever of 1821 v 
was this season but seldom observed. The black "vomit was 
also rare ; though black, dark green and livid stools were 
common. Vomiting of discolored matter, of \ arious shades, 
brown, snuff or clay colored, olive, green, &c. was fre- 
quently observed. The vomiting of these brown and dark 
colored fluids was generally an indication of a severe and 
dangerous disease. 

Prostration at the commencement of the disease was less 
frequent than in patients of the preceding season. There 
was, however, in many patients a great disposition to affec- 
tions of the brain; there was generally a considerable de- 
termination to this organ; and often the intellect was com* 
pletely deranged, or entirely annihilated during the ex- 
acerbation of the disease. 

The fever w r as more of the remitting and intermitting 
character than in 1821; but notwithstanding the complete 
remission or even intermission of the fever, symptoms of 
extreme danger and malignity frequently appeared during 
the continuance of the paroxysm. This was generally ush- 
ered in with a chill of greater or less severity, and of differ- 
ent and uncertain duration. As the sensation of chilliness 
went off the fever gradually rose. In several instances the 
patients complained of greatheat, when the skin to the touch 
felt no warmer than natural. Others complained of cold 
when the skin was preternaturally hot. 

Irregularities of the paroxysms was one of the most stri- 
king peculiarities of this epidemic. The disease would 
sometimes come on with the symptoms of fever and ague ; 
being ushered in with a strong sensation of cold and a se- 
vere shivering. This would be followed by one or two re- 
gular paroxysms of the fever and ague ; the intermissions, 
however, would become less considerable, so, that at length, 
the disease would assume the complete continued form ; hx 
which, although there might be a slight mitigation of the 
symptoms, yet at no time would the remission amount to a 
complete apyrexia or absence of fever. It is difficult to de- 
termine how long the fever would have remained in this con- 
tinued state without the aid of medicine ; this much is cer- 
tain,, that the more the fever assumed the continued form, 
in the same degree did it become more obstinate and malig- 



Bilious Remitting ar Endemic Fever of 1822. A%1 

aant in its nature. On some occasions I have known the 
fe* er to continue a week or more, with scarcely any abate- 
ment of its symptoms; and at no period of this time was 
there a sufficient remission to authorise the use of the bark. 

The heat and excitement were not unfrequently very un- 
equally distributed. In general there was an unusual ac- 
cumulation of heat and irritation about the epigastrium, or 
pit of the stomach; the head was also hot and painful. In 
a few the extremities were unusually hot, while the body 
possessed no more than its natural temperature. 

Palpitation of the heart appeared to be less frequent than 
it was during the preceding season: though an irregular 
and intermitting pulse was often observable. The latter has 
generally been considered a fatal symptom ; although this 
was by no means generally the case in the disease under 
consideration, yet, usually, it was an indication of great 
malignity and danger. 

The appearance of the tongue was various. In many 
cases, and in some which were marked with pretty severe 
symptoms, it was very little altered from its healthy state; 
appearing of a bluish or lead color, from the thinness of the 
fur spread upon its surface. This was more especially the 
case with patients in whom there was at the same time a 
strong tendency of typhus. In such cases there was frequent- 
ly an absence of all inflammatory symptoms, or high febrile 
action ; the pulse becoming frequent, soft and tremulous, 
easily compressible, with very little strength or firmness of 
action. In such cases the face would sometimes become 
flushed, and a circumscribed dark red, or purple spot would 
appear upon both cheeks. The latter symptom was a source 
of deception to the inexperienced, in as much as it was mis- 
taken for the color of returning health ; from which, indeed, 
it was very different, both in its real character and appear- 
ance. This dark red, purpleish, or bluish suffusion was not 
confined in every instance to the face, but in a few affected 
also the arms, breast and throat. It generally appeared in 
the latter stage of the disease, and after the disappearance 
of the more acute symptoms of excitement. As but one 
patient in the writer's practice fell a victim to this fever alone, 
this symptom could by no means be considered as a fatal one, 
though it was in the more violent and malignant cases that 
it made its appearance. * 

The thirst was not generally very great, except where 
sickness of the stomach prevailed, and there was a frequent 
vomiting or effort to vomit, the thirst was then excessive 
and insatiable, and such was tl;e irritability of tl}e stomach 



428 Bilious Remitting or Endemic Fever of 1822* 

that whatever was received was almost sure to be instantly 
rejected. 

Suppression of urine sometimes took place : this symp- 
tom, however, was of rare occurrence. The urine during 
the paroxysm was often pale and watery, though sometimes 
small in quantity and high colored. During the remission 
it was more or less of a reddish orange cast, and deposited 
a lateritious and cloudy sediment. 

Persons of superficial observation might be inclined to 
believe that perspiration could scarcely be considered as a 
critical solution of this disease ; for many patients recover- 
ed with i cry little appearance of this excretion ; and in oth- 
ers it was more or less profuse without affording any sensi- 
ble relief. It often happened that the perspiration was pro- 
fuse on the subsidence of the first paroxysm, and very par- 
tial and inconsiderable afterwards. It is, however, worthy 
of observation that the most perfect crisis were those atten- 
ded with a free, warm and general perspiration ; continuing 
from ten to twenty- four hours. On the other hand, where 
the fever went off with but a little or partial appearance of 
this salutary discharge, the crisis never appeared to be 
complete and perfect: the person generally, remaining in a 
feverish state, listless, languid, inacti* e, and unable to take 
exercise without exciting a feverish commotion in the sys- 
tem. It was, moreover, remarked that when the paroxysm 
terminated by a free perspiration, the fever was of shorter 
continuance than in those cases where no perspiration ap- 
peared. A copious secretion and discharge of urine was vi- 
carious of perspiration and often proved critical. 

Those copious cold clammy sweats, accompanying cases 
of sudden and extreme prostration, and which were so fre- 
quent in the fever of the preceding season, were much less 
common during the present epidemic. 

Hsemorrhagies, or bleedings from the nose, might in some 
cases be considered as critical discharges : they were howe- 
ver, more frequently the mark of an unusual determination 
of blood to the head ; and seemed to indicate the previous 
necessity of venesection. I never knew this discharge to be 
productive of any bad consequences ; on the contrary, it was 
pretty certain to afford relief to the pain of the head; which , 
generally attended or preceded this symptom, and which 
was often severe and distressing. This circumstance should 
be borne in mind, as in similar epidemics, it will prevent 
an over anxiety in the friends and attendants to stop the 
bleeding.^ 

•ram aware that there are Instances of epidemic bilious fev^ir wbeje ha£ 



Bilious Remitting or Endemic Fever of 1S22. 429' 

A discharge of blood by vomiting and purging was, like- 
wise, sometimes observed ; though no case of this descrip- 
tion which terminated fatally came within the author's 
knowledge or observation. 

Vomiting was frequently a troublesome symptom; after 
ushering in the cold stage it was not unusual for it to con- 
tinue through a considerable part of the hot stage ; thereby 
defeating our efforts to exhibit any thing by the mouth. 
This symptom, however, was neither so frequent nor so 
violent as it was during the preceding season. 

There was, generally, a considerable disposition to cos- 
tiveness; and frequency a difficulty in moving the bowels 
by the exhibition of cathartics. This was more especially 
the case in the early stage of the complaint, or at later 
periods, where medicines of sufficient strength had not been 
previously exhibited. Where the stomach and bowels had 
been well evacuated at the commencement, this disposition 
to constipation was in a great measure removed, and the 
bowels were thereby rendered soluble, and more easily ope- 
rated on at a subsequent period of the disorder. 

Hiccup, when occurring in the early stage of the disease, 
was not to be considered as an indication of iminent clan- 
ger, on the contrary it frequently took place at this period, 
and was then neither troublesome nor alarming; but when 
.supervening at an advanced stage of the disease, and where 
considerable debility already existed, it might then be look- 
ed upon as a dangerous and alarming symptom. It then 
often became deep, sonorous, and obstinate; agitating the 
Whole frame, and seeming to convulse every muscle of 
the body; at other times it was low, deep and gulping. Its 
continuance was debilitating and distressing. This symp- 
tom appears to have its seat in the stomach, thence calling 
the diaphragm into convulsive sympathy. This affection 
may be attributed to various causes, as 1st, to the applica- 
tion of some particular irritation when the stomach is in a 
debilitated state; 2dly, a degree of inflammation ; 3dlv, in- 
cipient mortification, or gangrene. Of these three condi- 
tions of this organ, it is probably the last, or a state 
bordering upon it, that gives rise to hiccup in the ad- 
vanced stage of bilious fever. Dissections after death de- 
monstrate that the stomach and bowels often suffer a very 

morrhagies from the nose and other parts are among the fatal symptoms. 
This was the case in the epidemic of the town of Natchez on the Missis* 
sippi, in the summer and autumn of 1823, where persons would he taken 
in the morning and die before night, with blood streaming from every 
®ifice in .the body. 



43a Bilious Remitting or Endemic Fever of 182&. 

considerable degree of inflammation in diseases of this chaV 
racter. Indeed, traces of inflammation, sometimes border- 
ing upon mortification, are almost invariably present in the 
stomachs and bowels of those who have died of the bilious 
or yellow fever; and sometimes mortification itself has 
been detected in the stomach after death. The presence 
or absence of hiccup is no certain criterion, however, of the 
degree in which the stomach may be affected : for although 
hiccup may, and does, attend inflammation of this or- 
gan during the latter stages of the disease, yet we know 
that inflammation frequently takes place without being ac- 
companied by hiccup. 

Symptoms of an uncommon and anomalous character ac- 
companied this disease in a few instances. In one patient 
I observed a violent palpitation or fluttering of the heart, 
accompanied with an entire derangement of the arterial sys- 
tem. In one arm the pulse was extremely rapid and inter- 
mitting, in the other it was regular and slower. In this pa- 
tient the febrile excitement was particularly increased in the 
extremeties and head ; the feet, hands and head being ex- 
tremely warm, whilst the temperature of the trunk was very 
little, if any, increased above the natural standard. The in- 
tellect for the time, that is, during the continuance of the 
paroxysm, was entirely annihilated, or suspended in its 
operation; violent impressions alone being able to rouse him* 
to any degree of consciousness, and then but for a moment ; 
the patient suddenly relapsing into his former state of leth- 
argy. The latter symptom was often observed both in the 
epidemic under consideration, as well as that of the prece- 
ding season. In the patient above alluded to, the puncture 
of the lancet in bleeding seemed to produce a momentary 
sensation, and occasioned a slight twitching of the arm : the 
affusion of cold water produced a more general shock, 
though consciousness was not restored by either. The fe- 
ver in this patient, as in most others, was of the remitting 
character ; and although the apyrexia was by no means 
perfect, yet it appeared sufficiently so to justify the use of 
the bark, which was exhibited in as liberal quantity as the 
patient could be prevailed upon to take it. He recovered, 

Local situation had considerable influence in modifying 
the character of this fever, and in rendering it more or less 
malignant. It was, generally, more severe upon the creeks 
and rivers, than at the distance of a mile or two from 
water courses, though upon the same stream, within 
(h? distance of a few miles, there was often a considerable, 
difference in the mildness or severity of the symptoms. 



Bilious Remitting or Endemic Fever of 1822. 4&1 

Though the disease often partook very much of the inter- 
mitting character, in being marked, in many instances, with, 
perfect intermissions, and the paroxysm again returning 
with severe chills or agues, yet it was of that description 
which Dr. Alibert, Dr. Hamilton and others call the atax- 
ique or Malignant Intermittent. Notwithstanding the pa- 
tient might feel comparatively comfortable during the re- 
mission, and even be able to walk about, yet when the par- 
oxysm returned and the fever rose, there was often the ap- 
pearance of iminent danger : the nervous system being very 
materially affected, as indicated by alienation of mind in a 
greater or less degree, and by the complete suspension in 
the exercise of the intellectual faculties. The latter might 
be called the lethargic state of fever; commencing with 
symptoms of high excitement in the vascular system, and 
going off gradually with the subsidence of the febrile action ; 
so that .when the fever had departed, the mind again became 
clear and tranquil. 

In those cases which indicated danger, the turn of the fe- 
ver, as it was called, was the critical period of life or death. 
When the hot stage had been suffered to run high, the powers 
of life became exhausted by the violence of the action, and 
the prostration which ensued as the fever subsided was often, 
surprising and irremediable ; life vanishing with the depar- 
ture of the fe er. But few cases of this description, howe- 
ver, came within my knowledge during this season ; in the 
epidemic of 1821 it was an occurrence of more frequent ob- 
servation. 

Sickness this season was particularly severe \ipon child- 
ren- In this town and vicinity the deaths were principally 
confined to them. This peculiarity appears to have been 
owing to the following causes. 1st, Early in the spring the 
measles made their appearance, and though not generally 
severe or malignant, yet had considerable influence in weak- 
ening and and deranging the constitution, and increasing 
its susceptibility to subsequent attacks of disease. 2dly, 
Upon the decline of the measles the hooping cough began 
to prevail, and at length became a general epidemic : the 
latter complaint was commonly severe and of long continu- 
ance. Towards the latter part of June, and as the hooping 
cough began to decline, the fever appeared. This was sud- 
den in its origin, and, at the commencement, attended with 
pretty severe and ^ iolont symptoms. The weather at this 
time was unusually hot; and for some weeks the atmosphere 
was not refreshed by a drop of rain. It has been said that 
■two general diseases of a different nature, cannot prevail in 



432 Bilious Remitting or Endemic fever ofi%%&„ 

the system at the same time : but if we admit, with nosol#« 
gysts, that hooping cough is a general disease, the advocates 
of this doctrine will be driven from their position, from the 
circumstances connected with the epidemic now under con- 
sideration: for in numerous instances I observed that the 
invasion and presence of fever had no influence in suspend- 
ing the progress or moderating the violence of the hooping 
cough. And it appears to have been owing to this combi- 
nation of diseases, in constitutions previously debilitated 
by the measles, that the unusual mortality among children 
this season was to be attributed. To this combination of 
diseases may also be added the dysentary, which was a com- 
mon complaint at the same tune: and it was not unusual 
to observe the three diseases, the fever, hooping cough and 
dysentary affecting the same patient simultaneously. It- 
might, however, be more proper to consider the dysentary 
as a symptom of fever than a distinct disease. This affec- 
tion of the bowels was often very distressing, and had a con- 
siderable share in accelerating the fatal termination in such 
children as became the victims of the disease. 

The fever in children was often ushered in with convul- 
sions, which were also liable to supervene and to be repeat- 
ed in the course of the disease. This was a dangerous 
symptom, very few recovering who were affected in this 
manner.* 

Throughout the progress of the fever the hooping cougte 
was often distressing and severe, and was sometimes among 
the last symptoms of the disease: the little patients, from 
the violence of the coughing, seemed, not unfrequently, to 
be in danger of suffocation. 

Children were more frequently affected with coma and 
stupor than grown persons. 

In this, as in the fever of the preceding season, worms 
Were frequently discharged by children, both by vomiting 
and stool. This symptom was apt to accompany the worst 
cases. 

I assisted this season at the opening of the body of an el- 
derly person, who died of bilious fever, in the neighborhood 
of this place, after a short illness. The inner surface of the 
stomach was found somewhat inflamed; but" what chiefly 
struck our attention was a considerable quantity of brown 
coffee colored fluid floating in the stomach with a black flo- 
culent sediment, resembling soot. We dipped out a saucer 

* Convulsiones cum febre acuta pernicium denunciant nimnim vero* 
pueris. Heppoc. Coac. Prscnot. Op. Om. p. 157. 



Bilious Remitting or Endemic Fever of 1822. -433 

full of this matter and fluid for more particular examination, 
and found its appearance as above stated. The bile, in the 
gall bladder was black and viscid, resembling tar in appear- 
ance and consistence, and perfectly free from any tinge of 
green. During the season of 1821, when the disease was 
more malignant than it was the present, I witnessed a 
number of cases, where matter similar to that abo> e descri= 
bed was discharged both by vomiting and stool. 

The disease this season required much the same treat- 
ment as that of the preceding summer and autumn ; vizc 
bleeding, emetics, the cold bath and other febrifuge remedies., 

Blood-letting at an early period of the complaint was gen- 
erally indicated by the strength, tenison and frequency of 
the pulse. The quantity to be drawn was regulated by the 
feel of the artery ; and, in general, the blood was permit- 
ted to run till an e ident change had taken place in the ac- 
tion of the vascular system. The pulse becoming soft and 
yielding afforded the best criterion for regulating the extent 
of this evacuation. Sometimes eight ounces might t>e suf- 
ficient for the purpose, at others sixteen and even twenty, at 
a single blood-letting, were required. In having recourse to 
this operation, as previously remarked, the age, sex and ha- 
bit of the patient, and the effects of the evacuation were 
leading considerations in the extent of the remedy. I re- 
marked that when the pulse was rendered softer and slower, 
the benefit was generally more sudden and considerable 
than when the pulse became softer and more frequent. To 
this, however, there were exceptions. Sometimes after a pret- 
ty free evacuation of blood, the pulse became frequent and in- 
termitting; to the inexperienced this might prove alarming; 
but where the operation had been authorised by the pre- 
vious state of the excitement, and high vascular action, no 
danger was to be apprehended; on the contrary, it was gen- 
erally found that blood-letting under these circumstances 
cut short the paroxysm, and contributed materially to bring 
ab®ut a critical solution of the fever. 

It was not in every case of fever that blood-letting seem- 
ed to be required. Where the arterial action was but little 
increased in frequency and force, the employment of veni- 
section was omitted ; not so much, however, from an ap- 
prehension chat it would prove injurious, as from the per- 
suasion that the cure might be safely committed to other 
means. But comparatively few cases, however, were of 
this description, even in cases of the mildest form, the ex- 
citement during the hot stage would run high, and authorise 
^nxl require the free use of the lancet, 
e3 



434 Bilious Remitting or Endemic Fever of 1822. 

The utility of blood-letting was not confined entirely to 
the commencement or early stage of the disease : On seve- 
ral occasions I was called to patients who had labored un- 
der the fever for four, five or six days, and whom, from the 
high action, strength and tenison of the pulse, I had then no 
hesitation in bleeding for the first time : nor did I ever have 
occasion to repent the employment of this remedy under 
these circumstances; even when blood letting had been per- 
formed in proper quantity at the commencement, it was of- 
ten proper to repeat it during the progress of the disorder. 
Sometimes bleeding was required once or twice a day, for 
two or three days in succession : for though there might be 
a temporary abatement of the symptoms from the operation^ 
yet the pulse, in a few hours, would often acquire its former; 
strength and hardness. In such cases there seemed to be a 
great disposition to local congestion and inflammation; and 
the blood drawn would frequently exhibit a thick buffy coat, 
or inflammatory crust upon its surface. 

As to the stage in which blood-letting was most proper 
and beneficial, it may be useful to make a few remarks. As 
this disease was generally of the remitting character, con- 
sisting of distinct and repeated paroxysms; the only period 
at which this remedy could be employed with decided ad- 
vantage, was the hot stage, and whilst the fever was at its 
height. The object of venesection is to diminish the vio- 
lence of the excitement and allay the inflammatory action ; 
thereby relieving the general system and the overstrained 
vessels of the different organs and viscera of the body; and, 
in this manner, anticipating what would be less perfectly ac- 
complished by the regular and uninterrupted course of the 
paroxysm. Besides, the debility produced by blood-letting 
is but temporary, and, according to the language of the Bru- 
nonean school, of the direct kind ; that is, debility produ- 
ced by abstraction of stimulus ; whereas the debility occa- 
sioned by the excitement which pre rails in the paroxysm of 
fever is of the indirect kind and more permanent in its na- 
ture. From this view of the subject it appears that blood- 
letting at any other time than in the height of the paroxysm 
must be of doubtful utility. For if employed during the 
abatement of the fever, under ordinary circumstances, the 
directly debilitating effects of this evacuation are added to 
the indirect debility occasioned by the paroxysm : and if 
had recourse to during the apyrexia, its employment must 
be without object or design, as there is no indication of 
cure which it can possibly accomplish at this period. 
It often happened that the fever assumed the continued 



Bilious Remitting or Endemic Fever of 1822. 435 

type, that is, I have known it to last two or three days with- 
out any sensible abatement; in such cases blood-letting 
could scarcely be mistimed, or employed to the disadvan- 
tage of the patient. In recent cases, also, where the pulse 
was bard and strong, and in robust constitutions, blood-let- 
ting was employed with advantage during the remission. 

After the bleedings if this had been required, as it com- 
monly was at the commencement of the disease, an emetic 
was generally exhibited. Much depended upon the proper 
administration of this remedy, and in nothing was the pre- 
sence of the physician more required than in the exhibition 
©f this article. Such was the difference in the irritability 
of the stomachs of different persons, and in the difficulty or 
facility of exciting the action of vomiting, that a dose which 
would operate severely upon one, would produce scarcely 
any impression upon another. The emetic generally em- 
ployed was the tartarised antimony, dissolved in warm wa- 
ter, and exhibited in divided doses. Commonly from six 
to ten grains was sufficient. To exhibit more was unsafe, 
and even in this quantity, unless it was thrown off by vomit- 
ing, it was apt to operate as a powerful cathartic; and in 
malignant cases great and sudden prostration would some- 
times be occasioned by it. In persons of delicate and de- 
bilitated habits, and where emetics were indicated in the pro- 
gress of the disease, I gave ipecacuanha and white vitriol in 
combination. This operated mildly, and could be repeated, 
so as to cleanse the stomach effectually, without incurring 
the danger of prostration ; fifteen grains of white vitriol and 
fifteen of ipecac, was a moderate, and a generally sufficient 
dose for an adult. 

Such was the disposition to accumulations of bile in this 
disease, that the repetition of emetics in the progress of the 
disorder was sometimes necessary: where the bowels, how- 
ever, were kept properly evacuated, this was seldom requi- 
red. The effects of this remedy were sometimes surprising. 
I have seen patients laboring under bilious feyer in whom 
the presence of typhus was strongly marked with symptoms 
of iminent danger, such as stupor and derangement of mind, 
a frequent, small and weak pulse ; who were suddenly re- 
lieved by the operation of a few grains of white vitriol. 

After the emetic had operated freely, the patient, if he 
had been much fatigued by it, was permitted to rest for a 
few hours before a cathartic was exhibited. It often hap- 
pened, however, that the tartarised antimony also acted as 
a cathartic ; this was more especially the case in those in- 
stances where it had exerted but little hvjiueii ce as an emetic. 



406 Bilious Remitting or Endemic Fever of 1822. 

Previously to the exhibition of the cathartic it was neces- 
sary to attend to the state and condition of the patient • for 
if the disease was of a malignant character, however neces- 
sary it might be to procure free evacuations from the stom- 
ach and bowels, the patient was in danger of being prostra- 
ted by the too considerable operation of the medicines em- 
ployed, or by their too frequent or rapid exhibition. This 
prostration of strength was more apt to ensue from giving 
an emetic or cathartic during the paroxysm, than from their 
employment in the absence of fever ; and in proportion to 
the malignancy of the disease. Such was the disposition t® 
prostration and collapse from the operation of evacuating 
medicines,that I have seen patients, who in the morning were 
able to walk about, to be affected before night with cold 
clammy sweats, sunk eyes, li% id and dejected countences ; 
the pulse, at the same time, being weak, frequent and scarce- 
ly perceptible, and all this from the exhibition of a dose of 
tartar emetic during the paroxysm. Such consequences as 
this, however, were more apt to take place in the epidemic 
of the preceding season than in the one under consideration. 

With respect to the employment of cathartics and the cold 
bath, little need be added to what has already been said up- 
on the same subject in treating of the fever of the preceding 
season. 

In place of calomel and jalap, I generally exhibited 
calomel and castor oil. I found the latter less offensive to 
the stomach than calomel and the former, less apt to nau- 
seate and produce griping, and at the same time quite as 
certain and effectual in its operation. From ten to fifteen 
grains of calomel and an ounce of castor oil was the usual 
dose for a grown person. 

A very useful laxative, used in the progress of the com- 
plaint was cream of tartar. Where a mild cathartic was re- 
quired, as in those cases in which the fever was moderate,, 
this medicine was exhibited with advantage. Where a fe- 
brifuge also was necessary between the exhibitions of more 
acti v e doses of medicine, I have given this in combination 
with spirits of nitre with decided benefit. My directions 
were to give a tea spoonful of spirits of nitre and about an 
even tea spoonful of cream of tartar every two or three 
hours during the continuance of the fever. 

Where the fever was of the low, nervous, or typhiod cha» 
racter, with a clean moist tongue, a small, frequent and soft 
pulse, sick stomach and a dry skin, I have given, with the 
best effect, powders composed of antimonial or James' pow- 
der three grains, nitre sjx grains, calomel from one to t\yc 



Bilious Remitting or Endemic Fever 0/1822. 43 f 

grains, and camphor three grains every three hours, assisted 
in their operation with a little warm herb tea ; they were 
very effectual in promoting perspiration, quieting the sick- 
ness of the stomach, and in bringing the fever to a salutary 
crisis. 

The cold bath was employed this season with considera- 
ble benefit. It was not, however, in every instance equally 
ser'iceable; and in some cases it was used without procu- 
ring any permanent relief. This much, however, may be 
said in its favor, that when it failed in proving manifestly 
advantageous I never knew it produce any injury; ana the 
numerous instances in which it proved serviceable entitle it 
to a high consideration among the remedies of bilious remit- 
ting fever. 

In the use of the cold bath regard should be had to the 
quantity of the water afFused, as more than is necessary to 
reduce the temperature of the body to a certain degree may 
produce injurious effects: eight or ten gallons, or a couple 
of common buckets full, were generally found sufficient, 
It was in some instances necessary to repeat the remedy 
two or three times in the course of as many hours, before 
the desired effects were produced. In most cases, however, 
it happened that even one affusion produced an abatement 
of the fever, and frequently the appearance of perspiration 
on the surfaces of those who for many hours had been 
parched with a burning fever. 

Where the remissions were pretty distinct the bark wa& 
generally exhibited with advantage. There were many ca- 
ses, however, in which this medicine could not be taken in 
any quantity without discomposing the patient and aggra- 
vating the complaint ; occasioning a distressing sickness, 
restlessness and anxiety, flushing of the face, and an in- 
crease or return of the fever. These consequences of its 
exhibition seemed, however, to occur principally in those 
patients whose stomachs and bowels had not been sufficient- 
ly cleansed, and in whom there was a considerable redun- 
dancy of bile. Though in many cases it could not be clearly 
ascertained whether the bark would prove beneficial or oth- 
erwise, yet in general where the fever had subsided with 
the appearance of a universal perspiration, where the intel- 
lect was clear, the patient composed and free from anxiety 
or any particular uneasiness, the bark was exhibited with a 
fair prospect of success: and even in cases of an opposite 
description, where there existed a considerable degree of 
head-ache, some fever, uneasiness, &c. the bark was often 
given with the best effect. It likewise proved, on many oc- 



438 Bilious Remitting or Endemic Fever of 1822. 

casicns, an efficacious diaphoretic : persons, whose skins had 
been uniformly dry, would often become moist, with a kind- 
ly perspiration over the whole surface of the body, upon ta- 
king one or two doses of bark. Generally the bark acted as 
a moderate laxative, though in some it had a contrary effect 
upon the bowels; and in such apperient medicines were 
required to keep up the regular action of the intestinal ca- 
nal. Independent of any particular condition produced by 
the fever itself- there appeared to be some stomachs of such 
an irritable nature as not to bear this remedy in any form 
or quantity. It often happened that when the bark in sub- 
stance nauseated, it might still be taken without producing 
any inconvenience, when given in decoction or infusion with 
the addition of some aromatic, as cloves, mace, cinnamon, 
&c. In preparing the infusion, directions were given to 
pour a point of boiling water to a table spoonful and a half 
of bark, to which a little coarsely powdered cinnamon and 
a few cloves had been added. Of this the patient was 
directed to take a wine glass every hour, or in such quanti- 
ty and as often as the stomach would bear. If in this way 
the patient could not bear the mixture of bark, the liquor 
was directed to be poured off and taken clear. 

Where the paroxysms, as often happened, were attended 
with dangerous and alarming symptoms, expediency and 
prudence required that we should use every means to pre- 
vent their return : with this view I have directed an ounce 
of bark, and even two ounces, when the stomach could bear 
it, to be taken in the morning, or a few hours before the ex- 
pected return of the paroxysm, in the quantity of two or 
three drachms at a dose, repeated every hour, in the man- 
ner of Torti. It often happened, in cases where the fe^er 
had not entirely subsided, that the exhibition of one or two 
doses of bark had the effect of subduing the slight febrile 
action that previously existed, especially if perspiration was 
produced. I have never found, however, in the course of 
my practice, what other physicians have stated as having 
experienced, viz. the benefit and efficacy of bark exhibited 
throughout the paroxysm, as well when the fever was at its 
height as during its remission : but on the contrary from the 
carelessness or want of discrimination in the nurses and at- 
tendants, I have known very unpleasant symptoms occasion- 
ed by the exhibition of this article, when a considerable de- 
gree of fever prevailed at the same time. The practice of 
prescribing bark throughout the paroxysm of fever, appears 
to be founded in a speculatr e and erroneous theory of the 
disease, viz, that its proximate cause consists in debility, 



Bilious Remitting or Endemic Fever of 1822. 43-9- 

and that to cure the fever we must overcome this debility 
by the use of tonics, without regard to the symptoms; a 
theory as pernicious in its application as it is unfounded in 
fact. 

There is one circumstance which it is of some importance 
to bear in mind, viz. that unless the stomach and bowels 
have been pretty well cleansed from redundancy of bile, the 
bark will prove of little benefit, and in all probability will 
aggravate the symptoms. This is very apt to be the case 
in the early stage of the bilious fever, where, although no 
evacuations have been made, the fever remits in the usual 
manner, and these remissions are imprudently seized upon 
as fair opportunities for exhibiting the bark. It is scarcely 
necessary to observe, that under these circumstances, with 
the stomach and bowels abounding with bile and impuri- 
ties, no benefit can be expected to result from the exhibition 
of this otherwise useful medicine. The attendants, friends, 
and physician were, perhaps, nattered with the belief, that 
from the preceding mildness of the symptoms, and the corn- 
piece absence of the fever during the apyrexia or remission, 
that no danger was to be apprehended : the succeeding par- 
oxysm, however, convinces them of their error, when they 
find that in spite of all their untimely efforts, the strength 
to fail, the pulse to sink, and a deadly coldness to extend, by 
degrees, from the extremeties to the heart itself. 

It generally happened after a severe attack of the endemic, 
that the patient during the continuance cf the infirm and 
debilitated state which succeeded, was liable to frequent 
returns of fever ; and it was by no means rare for these 
subsequent attacks to be as severe as the primary disease. 
It is obvious that suh relapses required the same treatment 
as the original disorder; with due regard to, however, and 
allowance for, the existing debility. Even under the most 
favorable circumstances, invalids from this disease was of- 
ten, and I believe generally, subject to relapses more or less 
severe. In many cases these were nothing more than slight 
chills and fevers, unattended with malignancy or danger. It 
was here by no means necessary to carry the patient through 
the whole routine of medical treatment required in the prima- 
ry disease,. Operating on nerves and fibres relaxed and un- 
strung by preceding illness, a slight exposure, fatigue or act 
of imprudence is sufficient to occasion a feverish disorder 
in the system. In such cases it was generally sufficient to 
exhibit some gentle purgative, as cream of tartar, castor oil, 
he. to cleanse the bowels and quell the k- er-, and after its 
operation, during the remission, to take the bark freely ? 



«$40 Bilious Remitting or Endemic Fever of 18%%. 

which was continued in pretty liberal quantity for a day oi* 
two, and then gradually diminished and continued for a few 
days longer, till the strength, was in some degree confirmed, 
and the constitution secured against relapse. 

There is an anomolous symptom in the intermitting as 
well as in the remitting fevers, which, though not peculiar 
to the epidemic under consideration, yet as it has not been 
previously mentioned it may not be improper to notice in 
this place. Instead of chills and fevers the patient would be 
seized every day, or every other day, with a severe pain in 
some part of the body, as the head, eyes, back, calves of the 
legs, &c. One day there would, perhaps, be a fever atten- 
ded with this excruciating pain, and the next the local affec- 
tion would be unattended by any febrile affection, and so on. 
alternately. Complaints of this nature are sometimes look- 
fed upon as strange and alarming by those who are ignorant 
of the protiform character of fever, but in this a per- 
son of experience can never be mistaken. These local pe- 
riodical affections were treated in the same way as the fever 
and ague. The return of pain might be anticipated and 
presented by exhibiting eighty or a hundred drops of lau- 
danum about an hour and a half, or two hours, before the 
attack was expected ; or by taking an ounce or two of bark 
between the paroxysms. 

In the debilitated state in which the body is left after an 
attack of bilious fever, and whilst a slight fever with irregular 
evening exacerbations still hangs about the patient, in this 
enfeebled and relaxed condition of the system, the mineral 
acids were given with the greatest advantage. For this pur- 
pose either the nitric or muriatic acid was employed. If 
there was any degree of, or disposition to viseral affections, 
particularly of the liver or spleen, as often happened, the ni- 
tric was peculiarly serviceable, in as much as it acted as an 
alterative, a general resolvent and remover of obstructions, 
a corrector of the vitiated or scorbutic state of the fluids 
produced by fever, and atonic and stomachic, without pro- 
ducing any feverish excitement. I have gi en from thirty 
to forty drops of the nitric acid five or six times a day, for 
se . era! days, and even a month or more. To about thirty- 
five drops of acid half a pint of water may be added, and su- 
gar or molasses sufficient to cover and conceal its rough- 
ness. If the stomach is not able to bear it in this quantity 
the dose may be diminished. A.s the muriatic acid is not 
so strong, a larger quantity should be exhibited. 

Having spoken pretty fully upon the subject of acids, 
Voth of the mineral and vegetable kingdoms, under the head 



Bilious Remitting or Endemic Fever ofi%22. 441 

of the general treatment of fever, the less will be necessary 
here. I will, however, remark, that from my own experience 
I am fully satisfied of their superior utility and importance. 
In all malignant cases, where typhoid symptoms showed 
themselves early, the nitric and muriatic acids were exhib- 
ited with decided advantage. The time is probably coming 
when the vegetable and mineral acids, from general expe- 
rience, will be found as specific in the cure of fever, as they 
are in the prevention and cure of scurvy. This is not 
to be taken as the extravagance of opinion, founded on hy- 
pothesis, and unsupported by truth and probability, but as 
the result of experience and correct principles in medicine. 
Consequences of Fever, — Affections of the liver and spleen 
are common consequences of bilious fever. The spleen is 
also frequently enlarged from along continuance or repeat- 
ed paroxysms of the fever and ague. This Istter complaint 
is sometimes productive of much inconvenience and danger; 
by its weight, bulk and by the compression of the neighboring 
parts, it renders the breath short, laborious and panting, up- 
on any sudden exertion; the countenance becomes pale and 
bloated, the person weak and emaciated, dropsy ensues and 
death closes the scene. I have on several occasions seen 
the spleen so much enlarged as to occupy nearly the whole 
circumference of the abdomen, filling completely the whole 
of the left side, projecting up into the thorax and down to 
the lower extremity of the pelvis, rendering the patient's 
body stiff and almost inflexible, extending past the linea 
alba and a considerable distance into the right portion of 
the abdomen. My success in the treatment of such cases 
has thrown a great number within my observation. My 
principal remedies are nitric acid, calomel and irictions over 
the seat of the diseased viscus with mercurial ointment ; to 
these remedies are sometimes added venesection, and the 
use of an active cathartic once or twice a week. Thecalo-* 
mel is given in the quantity of from two to four grains dai- 
ly ,until the mouth has become slightly affected, which is kept 
in this state until a cure is accomplished. The nitric acid 
is exhibited at the same time, in the quantity of twenty-five 
or thirty drops in half a pint of water, well sweetened, four 
times a day. A small piece of mercurial ointment is rubbed 
upon the abdomen three or four times a day : independent 
of the ointment, the friction itself is of very considerable 
benefit, in promoting absorption and resolving the enlarge- 
ment. To all of which may be added the use of exercise on 
horseback, daily, to such an extent as the strength of the pa- 
tient will admit. 

f3 



442 Bilious Remitting or Endemic Fever of 1822. 

In most instances this enlargement of the spleen decreases 
with the progressive improvement of the general health of 
the patient during the period of convalescence ; in others, 
instead of diminishing, it remains stationary, or continues 
to increase. 

Enlargements and schirrosities of the liver required the 
same treatment as those of the spleen. In both, spirituous 
liquors and animal food should be religiously abstained 
from; vegetables of easy digestion, fruits and vegetable acids 
may be eaten in moderation'; care being taken not to 
overload the stomach, so as to produce flatulency and indi- 
gestion. 

The plan of treatment above laid down I consider as spe- 
cific in the cure of those affections, as the use of bark is in the 
cure of intermitting fever ; so successful, indeed, has it been 
in my hands that I have never met with a single failure. 

To expedite the cure in cases of enlargement of the spleen, 
where there is no fever, I sometimes prescribe, in cases of 
debility, vegetable bitters. 

Where dropsy accompanies these enlargements I give 
digitalis, after the gums have become affected by the exhi- 
bition of mercury. The preparation I employ is the dried 
leaves pulverised, from one to two grains three times a day; 
to be continued till the head becomes affected with vertigo; 
the stomach with nausea, or until the pulse is rendered con- 
siderably slower ; it is then discontinued a few days, and 
again resumed should the symptoms require it. Vinegar 
of squills, saturated with nitrate of potash, is also employed, 
a tea spoonfnl three times a day : For constant and only 
drink the patient is ordered to use cream of tartar and wa- 
ter, in the proportion of a tea spoonful of the former to hall* 
a pint of the latter — in addition to all which I prescribe a 
dose of cream of tartar and jalap once or twice a week, ac- 
cording to the strength of the patient: exhibiting from half 
an ounce to an ounce of cream of tartar and from twenty to 
forty grains of jalap, according to the facility and power 
with which these medicines operate on different patients ; re* 
gulating the quantity so as to cause a brisk operation. 



FINIS. 



j-[BRARY OF CONGRESS^ | 

021 067 355 6 



